How do you approach short-term steroid use in a breastfeeding mother with an exacerbation of CSU?

I prefer short bursts with low-dose steroids; however, please remember that steroids transfer poorly into the mother's milk, with about 1% of the drug passing through to the infant. For this reason, and also because the peak occurs about an hour after taking the steroid, maybe have the mother breastfeed before she takes the Steroid and then delay breastfeeding for a few hours after. For high doses or prolonged therapy, I think it’s best to address risk versus benefit.