Meta‐Analysis on the Harm of Systemic Glucocorticosteroids in Inflammatory Upper Airway Disease and Asthma: An EAACI Task Force
Year: 2026
Type: article
Study designs: Systematic Review, Meta-Analysis
Abstract: Systemic glucocorticosteroids (sGCS) are widely used in the treatment of chronic inflammatory airway diseases such as rhinitis, rhinosinusitis and asthma. It is well-known that systemic use is linked to multiple adverse effects (AEs) both in the short- and the long-term. However, less is known about the safety of multiple short courses of sGCS. Currently there is no established agreement on the acceptable cumulative exposure to sGCS, considering the potential for various AEs. This systematic review and meta-analysis evaluated sGCS-related AEs in both upper and lower inflammatory airway disease, with a particular focus on short- and long-term risks. We further evaluated whether a dose-response relationship existed between the daily and cumulative dosages of sGCS and the occurrence of those AEs. Our meta-analysis confirmed that cumulative dosages between 500 mg and 1 g prednisolone-equivalent significantly increase the risk of most AEs, with risks increasing with incremental dose. These findings underscore the importance of: (a) judicious sGCS prescription and need for steroid stewardship, due to their potential for short- and long-term complications, occurring even with repeated short courses, and (b) prioritization of steroid-sparing approaches (e.g., biologicals) to avoid reaching a cumulative dose of 500 mg.
Source: Allergy
DOI: 10.1111/all.70332
Authors: Sophie Scheire, Evelijn Lourijsen, Manon Blauwblomme, Maria Dib, Ioana Agache, Claus Bachert, Koen Boussery, Adam Chaker, Roos Colman, Stefano Del Giacco, Ibon Eguiluz‐Gracia, Wytske Fokkens, Simon Gane, Peter Hellings, Claire Hopkins, Ludger Klimek, Miguel Maldonado, Juan Maza‐Solano, Ralph Mösges, Joaquim Mullol, Charles Pilette, Oliver Pfaar, Sietze Reitsma, Michael Rudenko, Mohamed H. Shamji, Peter Valentin Tomazic, Sanna Toppila‐Salmi, Philippe Gevaert, Valerie Hox
Institutions: Ghent University, Amsterdam University Medical Centers, Universitätsmedizin Greifswald, Universität Greifswald, Transylvania University of Brașov, University Hospital Münster, The First Affiliated Hospital, Sun Yat-sen University, TUM Klinikum, Technical University of Munich, University of Cagliari, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, University College Hospital, University College London, Universitair Ziekenhuis Leuven, King's College London, Zentrum für Rhinologie und Allergologie, Hospital Vital Álvarez-Buylla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, University of Cologne, Hospital Clínic de Barcelona, Universitat de Barcelona, Cliniques Universitaires Saint-Luc, Philipps University of Marburg, NIHR Imperial Biomedical Research Centre, Imperial College London, Medical University of Graz, University of Helsinki, University of Eastern Finland, Helsinki University Hospital
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7155032696