From the Guidelines
For acute allergic urticaria, prednisolone is recommended at a dose of 50 mg daily for 3 days in adults, as it may shorten the duration of the condition. This recommendation is based on the guidelines for evaluation and management of urticaria in adults and children, published in the British Journal of Dermatology in 2007 1. The medication should be taken in the morning with food to minimize gastrointestinal side effects.
Key Considerations
- No tapering is usually required for such short courses.
- Children's dosing is weight-based, generally 1-2 mg/kg/day, not exceeding 60 mg daily.
- Prednisolone works by suppressing the inflammatory and immune responses that cause urticaria symptoms, reducing itching, redness, and swelling.
- It should be used alongside first-line antihistamines for optimal relief.
- Patients should be aware that corticosteroids are generally reserved for severe or unresponsive cases due to potential side effects with prolonged use.
Additional Guidance
While taking prednisolone, patients should continue to avoid identified triggers, maintain good skin hydration, and monitor for improvement. If symptoms persist beyond the treatment course or recur frequently, further medical evaluation is recommended to identify potential underlying causes. Although another study published in the Journal of Allergy and Clinical Immunology in 2010 1 discusses the use of prednisone, the more specific and relevant guideline for urticaria management is from the British Journal of Dermatology 1.
From the FDA Drug Label
Allergic States: Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in adult and pediatric populations with: seasonal or perennial allergic rhinitis; asthma; contact dermatitis; atopic dermatitis; serum sickness; drug hypersensitivity reactions.
The recommended treatment for acute allergic urticaria using prednisolone is not explicitly stated in the drug label. However, prednisolone is indicated for the control of severe or incapacitating allergic conditions, which may include acute allergic urticaria.
- The use of prednisolone for acute allergic urticaria may be considered in cases where conventional treatment is inadequate.
- Prednisolone should be used with caution and under the guidance of a healthcare professional, as it is a corticosteroid and may have potential side effects 2.
From the Research
Treatment of Acute Allergic Urticaria with Prednisolone
- The use of prednisolone in treating acute allergic urticaria has been studied in several clinical trials 3, 4, 5.
- A study published in 1996 found that prednisolone (50 mg/day for 3 days) was effective in controlling whealing and symptoms ceased earlier in corticosteroid-treated patients, with complete remission occurring within 3 days of treatment in 93.8% of patients 3.
- Another study published in 2024 found that the addition of corticosteroid (prednisone) to an antihistamine did not improve symptoms of acute urticaria compared to antihistamine alone in two out of three RCTs 4.
- A study published in 1995 found that the addition of a prednisone burst improved the symptomatic and clinical response of acute urticaria to antihistamines, with patients' conditions improving more quickly and more completely when prednisone was administered 5.
Dosage and Administration
- The dosage of prednisolone used in the studies varied, with one study using 50 mg/day for 3 days 3 and another study using 20 mg every 12 hours for 4 days 5.
- The administration of prednisolone was oral in both studies.
Comparison with Other Treatments
- A study published in 2001 found that antihistamines, such as loratadine and cetirizine, were effective in treating urticarias, but there were few studies that documented the efficacy of second-generation antihistamines in the treatment of acute urticaria 6.
- Another study published in 1986 found that cimetidine, an H-2-receptor-blocking antihistamine, was effective in treating recalcitrant acute allergic urticaria 7.