Use of glucocorticoids in the treatment of acute urticaria - adapted from the Annals of Emergency Me

Date: April, 1996

Management of the patient with acute urticaria who does not have wheezing or angioedema has been limited to antihistamines and occasional subcutaneous epinephrine. Glucocorticoids are useful in chronic urticaria and in patients with acute, severe symptoms. Pollack and associates evaluated the usefulness of glucocorticoids in the treatment of acute uncomplicated urticaria.

Forty-three patients with an urticarial rash and no serious symptoms or previous treatment received diphenhydramine, 50 mg intramuscularly, followed by either hydroxyzine, 25 mg orally every four to eight hours for pruritus, plus prednisone, 20 mg orally every 12 hours for four days, or hydroxyzine plus placebo. Patients' conditions were reevaluated two days later with further follow-up five days after initiation of therapy.

Compliance with medication was good. At both days of follow-up, subjectively determined itch scores were significantly lower in patients who received prednisone than in patients who received placebo. As anticipated from other studies, prednisone in a dosage of 40 mg per day for four days was not associated with clinically significant toxicity or adrenal insufficiency after termination.

The authors conclude that, in the treatment of acute urticaria, a short course of prednisone can be effective when it is clinically indicated because of disabling pruritus, the need to minimuze use of sedating antihistamines, or recurrent or recalcitrant cases. The potential for complications of corticosteroid use, which are minimal in this short course, should be considered on an individual basis. (Pollack CV, et al. outpatient management of acute urticaria: the role of prednisone. Ann Emerg Med 1995;26:547-51.)

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