Inspired by one of our favorite television shows, Allergy Myth Busters looks at a number of popularly held beliefs about allergy. But are these myths just urban legends or are they true?
MYTH: My child’s height will be decreased if she/he uses inhaled corticosteroids (ICS).
THE SCIENCE: The affect of ICS on growth in children has been a concern of both healthcare providers and parents for the past 40 years. Although there have been many studies designed to address this concern, these studies were plagued by inadequate design and conflicting results.
A review of studies assessing whether increasing the dose of ICS is associated with slower linear growth, weight gain and skeletal maturation in children with asthma found a small but statistically significant difference in growth between the different doses clearly favoring the lower doses of ICS. The type of ICS did not seem to influence the impact on growth over one year. The authors recommended that the minimal effective ICS dose be used in all children with asthma. A study published in 2013 showed a small but significant decrease in growth in those subjects with positive skin tests to inhalant allergens, in female subjects and in those receiving intranasal steroids. The effect of ICS appears to occur in the first year and although persistent does not seem to be cumulative or progressive. A 2014 study showed that the systemic exposure to ICS is inversely related to age and body size and suggests dosing should be adjusted based on these parameters.
Although there are studies showing negative effects of ICS on growth, the majority show that both ICS and intranasal steroids have a long term effect on growth of about 1 cm. In light of recent studies that show intermittent ICS treatment to be equivalent to daily use in asthma treatment efficacy with a significantly less total dose, it would seem important to consider this option in treating children with asthma.
Though the effects of both inhaled and intranasal corticosteroids on adult height are small, this effect on height has to be balanced with the benefit that these medications provide in the treatment of asthma. Inhaled corticosteroids are the cornerstone of effective asthma management. Asthmatic children who are prescribed ICS should be followed regularly to ensure that they are tolerating the medicine well, are using the lowest effective dose, and have their growth monitored over time. Allergy Partners allergists are board certified or eligible and are experts in the diagnosis, treatment, and long term care of asthma and are committed to providing each patient with the individualized care he or she requires.
By Dr. Michael Blumberg
Allergy Partners of Richmond