From the Research
For an 80-year-old lady with urticaria, I recommend starting with prednisone 20-30 mg once daily for 3-5 days, then tapering by 5 mg every 2-3 days if symptoms are improving, as supported by the study published in 1995 1. This approach is based on the principle of minimizing side effects while effectively managing the condition. The use of steroids in elderly patients should be cautious due to potential side effects such as increased risk of falls, confusion, fluid retention, and worsening of conditions like hypertension, diabetes, and osteoporosis. However, in the context of acute severe urticaria or when antihistamines have failed, short-term steroid use can be beneficial. It's also important to note that long-term steroid use should be avoided, and the patient should be transitioned to non-sedating antihistamines like cetirizine 10 mg daily or loratadine 10 mg daily for maintenance therapy, as suggested by recent studies 2, 3. Some key points to consider in the management of urticaria in elderly patients include:
- The importance of short-term steroid use accompanied by a proton pump inhibitor like omeprazole 20 mg daily to protect the stomach
- Blood glucose monitoring during treatment, especially if the patient has diabetes
- The role of second-generation H1 antihistamines as first-line pharmacotherapy, which can be titrated to greater than standard doses if necessary, as mentioned in the study published in 2017 4
- The potential for other treatments such as omalizumab or cyclosporine in refractory cases, as discussed in the study published in 2023 2.