The National Prescribing Centre (NPC) has published MeReC Extra 27 that provides a reminder of maximum doses of inhaled steroids in children, an analysis of the consequences of thiazide related diabetes and an analysis of the evidence supporting Grazax®.
Individual sections are available as follows:
- Inhaled corticosteroids: children are at risk from high doses
- Development of diabetes with thiazides: what are the consequences?
- Grazax sublingual vaccine against grass pollen allergy
The first section reminds clinicians of the licensed doses of inhaled steroids in children. A recent study has identified links between prescribing of high doses inhaled steroids in young children and adrenal suppression. An observational study of GP prescribing is cited that recommends audits are carried out to identify children at high risk of adverse outcomes.
The analysis of the consequences of thiazide-induced diabetes discusses the findings of a post-hoc subgroup analysis of the ALLHAT study. The analysis found no significant association between fasting glucose changes and any of the study endpoints (death, CV disease or end-stage renal disease) in a combined analysis or for thiazides alone. Further investigation is required but this finding adds some weight to a 14-year follow-up of another study that suggests any observed excess in diabetes does not increase cardiovascular risk.
Grazax is only indicated following a positive allergen test to grass pollen (skin prick or specific IgE test). It is recommended that physicians with experience in the treatment of allergic disease initiate treatment. The first dose should also be taken under medical supervision due to the risk of allergic reactions. It is also noted that the absolute benefits of Grazax are modest and have not been compared with subcutaneous allergen immunotherapy.
Action: Clinicians who treat children with asthma, hypertension or grass pollen allergy will find this MeReC useful and informative.
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