No Benefit from Corticosteroids for Acute, Simple Urticaria

By Anne Harding

NEW YORK (Reuters Health) - Corticosteroids do not speed relief for patients presenting to the emergency department (ED) with acute urticaria, according to a new randomized trial.

“Adding a corticosteroid to antihistamine therapy for acute simple urticaria appears unnecessary,” Dr. Dominique Lauque of Centre Hospitalier Universitaire in Toulouse, France, one of the study’s authors, told Reuters Health by email. “Itch and rash relief are similar with and without corticosteroid.”

Several guidelines recommend corticosteroids to speed symptom relief, Dr. Lauque and her colleagues note in their report, published online May 3 in the Annals of Emergency Medicine, but the evidence base for the practice is slim.

“Despite the evidence that second-generation H1antihistamines treat acute urticaria without disturbing adverse effects, many physicians believe that corticosteroids are still the most effective treatment to obtain rapid symptom relief,” the researcher said. “Emergency physicians may be concerned that patients worsen after discharge and return to the ED with more severe symptoms or anaphylaxis.” However, she added, anaphylaxis is rare in these patients.

To investigate whether a prednisone burst would improve the effectiveness of antihistamine therapy, Dr. Lauque and her colleagues randomly assigned 100 patients to receive levocetirizine (5 mg orally for five days) plus four days of 40 mg oral prednisone or placebo.

Two days after visiting the ED, 62% of the patients given prednisone had an itch score of 0, compared to 76% of the placebo group. Relapses occurred in 30% of patients on prednisone and 24% of those on placebo.

“Short-term treatment with corticosteroids does not cause clinically significant toxicity, but recurrent or long-term treatment may have deleterious effects, especially in patients with comorbidity, such as diabetes or immunodepression,” Dr. Lauque told Reuters Health.

Based on the findings, the researcher added, “corticosteroids should not be recommended for acute urticaria without angioedema or other sign of anaphylaxis. The management of acute urticaria can be limited to avoidance of the allergen, when identified, and to symptomatic treatment with H1 antihistamines. Refractory cases must be referred to a dermatologist or allergist for investigations and diagnostic measures.”


Ann Emerg Med 2017.

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