Meta‐Analysis on the Harm of Systemic Glucocorticosteroids in Inflammatory Upper Airway Disease and Asthma: An EAACI Task Force

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.

Authors

Institutions

Publication Details

Journal
Allergy
Published
2026-04-21
DOI
https://doi.org/10.1111/all.70332
Primary Topic
Sinusitis and nasal conditions
Type
article
Field-Weighted Citation Impact
0.00

Funders

Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Meta‐Analysis on the Harm of Systemic Glucocorticosteroids in Inflammatory Upper Airway Disease and Asthma: An EAACI Task Force

Sophie Scheire, Michael Rudenko, Ralph Mösges, Simon Gane et al.
Allergy
Sinusitis and nasal conditions
article

Meta‐Analysis on the Harm of Systemic Glucocorticosteroids in Inflammatory Upper Airway Disease and Asthma: An EAACI Task Force

Sophie Scheire, Michael Rudenko, Ralph Mösges, Simon Gane, Ioana Agache, Roos Colman, Ludger Klimek, Manon Blauwblomme, Peter Valentin Tomazic, Adam Chaker, Koen Boussery, Maria Dib, Charles Pilette, Mohamed H. Shamji, Sietze Reitsma, Stefano R. Del Giacco, Ibon Eguíluz‐Gracia, Joaquim Mullol, Claire Hopkins, Miguel Maldonado Fernandez, J. Maza‐Solano, S. Toppila‐Salmi, O Pfaar, Wytske Fokkens, V Hox, P Gevaert, Evelijn Lourijsen, Claus Bachert, Peter Hellings
article en

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.

Allergy
University College Hospital (GB), Cliniques Universitaires Saint-Luc (BE), University of Helsinki (FI), Sun Yat-sen University (CN), Philipps University of Marburg (DE), University of Cagliari (IT), University of Eastern Finland (FI), University of Cologne (DE), King's College London (GB), Medical University of Graz (AT), Universitätsmedizin Greifswald (DE), Helsinki University Hospital (FI), Ghent University Hospital (BE), TUM Klinikum (DE), Transylvania University of Brașov (RO), Ghent University (BE), University Hospital Münster (DE), Hospital Regional Universitario de Málaga (ES), NIHR Imperial Biomedical Research Centre (GB), Hospital Clínic de Barcelona (ES), Emergency Services College (FI), Zentrum für Rhinologie und Allergologie (DE), The First Affiliated Hospital, Sun Yat-sen University (CN), Amsterdam University Medical Centers (NL), Hospital Universitario Virgen del Rocío (ES), Instituto de Investigación Biomédica de Málaga (ES), EntreChem (Spain) (ES), University College London (GB), Imperial College London (GB), Universidad de Sevilla (ES), University of Amsterdam (NL)
European Academy of Allergy and Clinical Immunology
Good health and well-being
Openalex Percentile: Top 8%
Sinusitis and nasal conditions
DOISourceOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.