Urticaria

[Pollack CV Jr, Romano TJ. Outpatient management of acute urticaria: The role
of prednisone. Ann Emerg Med November 1995;26:547-551.]

Showed that prednisone 20 BID for 4 days decreased itching scores.

OUTPATIENT MANAGEMENT OF ACUTE URTICARIA: THE ROLE OF PREDNISONE

Pollack, C.V., et al, Ann Emerg Med 26(5):547, November 1995

BACKGROUND: Patients with uncomplicated urticaria are generally treated with
H1 antihistamines, with the occasional addition of subcutaneous epinephrine
or H2 antihistamines for refractory cases. Steroid treatment has anecdotally
been observed to be beneficial.

METHODS: This randomized, controlled, double-blind study, from Maricopa
Medical Center in Phoenix, AZ, examined the effects of the addition of a
four-day course of oral prednisone to a regimen of IM diphenhydramine (50mg)
followed by oral hydroxyzine (25mg every four to eight hours for pruritis)
in nondiabetic adults presenting with acute urticaria in the absence of
wheezing, stridor or angioedema. A total of 43 patients were randomized to
be treated with either antihistamines alone or antihistamines plus
prednisone (20mg every twelve hours for four days).

RESULTS: Mean baseline pruritis scores were 7.4 (on a 10-point visual
analogue scale) in control patients and 8.1 in those treated with steroids.
Mean scores decreased to 4.4 in controls and 1.3 in the prednisone group at
48 hours (p=0.0001), and 1.6 compared with 0.0, respectively, at five days
(p=0.0001). There were no consistent differences between the groups in the
reported extent of the rash on follow-up, although by five days all of the
patients in the prednisone group reported complete absence of pruritis and
resolution of their rashes. Seventy-seven percent of the control patients
(14/19) reported some persistence of pruritis at five days. There were no
apparent steroid-related adverse effects.

CONCLUSIONS: The addition of a four-day "burst" of prednisone to a course of
hydroxyzine may be beneficial when adjunctive therapy is believed to be
indicated for patients with acute urticaria.