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Severe allergic contact dermatitis typically presents with significant inflammation, redness, swelling, and discomfort, often requiring a more aggressive treatment approach than mild cases. A prednisone taper is the recommended treatment for severe cases because it effectively reduces inflammation and manages symptoms associated with significant allergic reactions. Prednisone, a systemic corticosteroid, helps control the immune response and mitigate the severity of the dermatitis, facilitating faster healing and providing symptomatic relief.

Other treatments mentioned, such as topical antibiotics, are primarily used for preventing or treating secondary bacterial infections rather than addressing the underlying allergic reaction. Immediate cryotherapy is not a standard treatment for allergic contact dermatitis and is more often used for other dermatological conditions like warts. Over-the-counter antihistamines can provide relief from itching but do not address the underlying inflammatory process as effectively as a corticosteroid taper. Thus, the choice of a prednisone taper is appropriate and aligns with management guidelines for severe allergic contact dermatitis.