INTRAVENOUS CORTICOSTEROIDS - ADVERSE REACTIONS ARE MORE VARIABLE THAN EXPECTED IN CHILDREN

Objective: To determine the frequency and severity of adverse reaction s associated with high dose intermittent intravenous corticosteroids ( IVCS) in children with rheumatic disease. Methods: Prospective documen tation of adverse reactions associated with IVCS given to 213 pediatri c rheumatology patients over a 4 year period. Results. Forty-six of th e 213 children (22%) reported an adverse reaction. The 46 patients rec eived 2622 doses of NCS. Twenty-one patients (10% of all patients stud ied) had behavioral changes, including altered mood (14), hyperactivit y (4), psychosis (2), disorientation (1), and sleep disturbances (3), Nonbehavioral adverse reactions included headache (5.2%), abdominal co mplaints (4,7%), pruritus (4.2%), vomiting (3.8%), hives (2.3%), hyper tension (2.3%), bone pain (1.5%), dizziness (1.5%), fatigue (1%), leth argy (1%), hypotension (1%), tachycardia (1%), hyperglycemia (1%), fra cture (1%), tremor (0.5%), anaphylaxis (0.5%), ulcer (0.5%), and ''gra y appearance'' (0.5%). Using chi-squared analysis, there were no stati stical differences in ethnicity (p = 0.54) or diagnosis (p = 0.46) bet ween patient groups, with or without adverse reactions. There was a si gnificant statistical association between history of drug induced cuta neous reaction and adverse reactions to IVCS (p < 0.01). Conclusion. I VCS are associated with a spectrum of adverse reactions in children wi th rheumatic disease, of which volatile behavior is the most frequent. Children with a history of drug induced cutaneous reaction are more l ikely to have an adverse reaction to IVCS.