From the Guidelines
For diffuse full body urticaria, the most appropriate dose of prednisone is 40-60 mg daily for a short course of 3-5 days, as this approach helps minimize side effects while providing effective symptom relief. This recommendation is based on the principle of using oral corticosteroids for severe acute urticaria, as suggested by guidelines for evaluation and management of urticaria in adults and children 1. The use of prednisone should be restricted to short courses due to the potential for significant adverse effects with prolonged treatment.
When initiating prednisone for diffuse full body urticaria, it is essential to consider the following:
- The medication should be taken in the morning with food to reduce gastrointestinal irritation.
- First-line treatment for urticaria consists of non-sedating H1 antihistamines, and prednisone should be reserved for severe cases that don't respond adequately to antihistamines or when rapid relief is needed.
- Patients should be monitored for common side effects, including increased appetite, mood changes, insomnia, and elevated blood glucose.
- For recurrent or chronic urticaria, systemic steroids like prednisone are not recommended for long-term use due to significant adverse effects, and referral to an allergist or dermatologist should be considered for alternative treatments.
The rationale behind using a short course of prednisone is to suppress the inflammatory and immune responses that trigger histamine release and subsequent urticaria, as outlined in guidelines for managing urticaria 1. By limiting the duration of prednisone treatment, the risk of adverse effects is minimized, aligning with the principle of maximizing quality of life while effectively managing symptoms.
From the Research
Treatment of Diffuse Full Body Urticaria
- The most appropriate dose of prednisone for diffuse full body urticaria is not explicitly stated in the provided studies, but a study published in the Journal of investigational allergology & clinical immunology 2 suggests that a short course of oral prednisone, starting with 25 mg/day for 3 days, can be effective in treating antihistamine-resistant chronic urticaria.
Dosage and Efficacy
- The study found that nearly 50% of patients with chronic urticaria responded to a single short course of prednisone, and a second course induced remission in a further 9% of patients 2.
- Another study published in the Annals of dermatology 3 recommends up-dosing non-sedating antihistamines as the first line of treatment for urticaria, but does not provide guidance on the use of prednisone.
- A study published in the Journal of Harefuah 4 mentions the use of prednisone (5-10 mg/d) in combination with cyclosporine-A for the treatment of severe chronic urticaria, but does not provide information on the optimal dose of prednisone for diffuse full body urticaria.