Oral steroids in acute urticaria
Date First Published:
October 29, 2002
Last Updated:
January 21, 2004
Report by:
M Poon, Paediatric Registrar (Alice Springs Hospital, NT, Australia)
Search checked by:
C Reid, Alice Springs Hospital, NT, Australia
Three-Part Question:
In a [child with acute urticaria] does the [addition of oral steroids to antihistamines] lead to [more rapid resolution of symptoms]?
Clinical Scenario:
A 4 year old girl presents to the Emergency Department with an urticarial rash. Her general practitioner has prescribed an oral antihistamine but the rash has persisted. You wonder if there is a role for oral steroids in this otherwise well child.
Search Strategy:
Cochrane Database of Systematic Reviews Issue 3, 2003. Medline 1966-10/03 using the OVID interface.
Search Details:
Cochrane: 'urticaria'
Medline: [exp urticaria OR urticaria$.mp] AND [exp steroids OR steroid$.mp OR exp adrenal cortex hormones OR corticosteroid$.mp] AND [Randomized Controlled Trial.pt OR Controlled Clinical Trial.pt] LIMIT to human.
Medline: [exp urticaria OR urticaria$.mp] AND [exp steroids OR steroid$.mp OR exp adrenal cortex hormones OR corticosteroid$.mp] AND [Randomized Controlled Trial.pt OR Controlled Clinical Trial.pt] LIMIT to human.
Outcome:
Cochrane Database of Sytematic Reviews - no relevant results
Medline search results – 39 articles, of which 2 were relevant
Medline search results – 39 articles, of which 2 were relevant
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Outpatient management of acute urticaria: the role of prednisone. Pollack CV Jr, Romano TJ. 1995, USA | 43 adult outpatients with acute urticaria given im. diphenhydramine then randomised to oral hydroxyzine plus either 20mg prednisone 12hrly for 4 days or placebo | RCT | 10 point visual analogue Itch score at 48 hours | Mean 48 hour itch score 1.3 in prednisone group vs 4.4 in control group | Adult patients only Small study No power calculation Rash not described at 5 days in control group |
| Itch score at 5 days | 5 day itch score 0 in prednisone group vs 1.6 in control group | ||||
| Description of rash at 48 hours and 5 days | No difference between groups at 48 hours.Rash resolved completely at 5 days in prednisone group | ||||
| Acute urticaria: clinical aspects and therapeutic responsiveness. Zuberbier T, Ifflander J, Semmler C, et al. 1996, Germany | 109 adult and paediatric patients with acute urticaria treated with loratidine 10mg daily or prednisolone 50mg daily for 3 days followed by loratidine 10mg daily until remission of symptoms | Non-randomised prospective cohort study | Days until cessation of whealing | 65.9% of had cessation of whealing by 3 days and a further 15.9% by 7 days in Loratidine group, compared with 93.8% by 3 days and a further 3.1% by 7 days in the prednisolone group. Resolution in all patients after >21 days. NNT with prednisolone for resolution of symptoms by 3 days = 4 | Number of children unstated Different exclusion criteria between groups (potentially pregnant women excluded from loratidine group) |
Author Commentary:
There are no studies specifically aimed at children with acute urticaria. These limited trials demonstrate improvement in symptoms when prednisolone is prescribed, but larger studies are needed.
Bottom Line:
In patients presenting to the emergency department with acute uricaria, the addition of oral prednisolone to an antihistamine results in decreased itch and more rapid rash resolution.
References:
- Pollack CV Jr, Romano TJ.. Outpatient management of acute urticaria: the role of prednisone.
- Zuberbier T, Ifflander J, Semmler C, et al.. Acute urticaria: clinical aspects and therapeutic responsiveness.