From the Guidelines
A short course of prednisone is effective for treating severe acute urticaria, and should be restricted to short courses, as recommended by the British Journal of Dermatology guidelines 1. When considering the use of prednisone for urticaria, it's essential to weigh the benefits against potential side effects, prioritizing morbidity, mortality, and quality of life as outcomes.
- The primary goal of using prednisone in this context is to provide rapid relief from severe symptoms, such as angio-oedema affecting the mouth.
- According to the guidelines, oral corticosteroids like prednisone should be used for short courses, implying a duration that is as brief as possible while still effective, to minimize side effects.
- The specific dosage and duration may vary depending on the severity of the condition and individual patient factors, but the principle of using the shortest effective course applies.
- It's crucial to note that while prednisone can be effective for acute severe urticaria, it is not recommended for long-term management of chronic hives due to potential side effects, including mood changes, increased appetite, fluid retention, elevated blood sugar, and insomnia, as well as the risk of adrenal suppression with prolonged use.
- Therefore, the approach should always be to use prednisone judiciously, at the lowest effective dose, and for the shortest duration necessary to control symptoms, under the guidance of a healthcare provider, as suggested by the guidelines for evaluation and management of urticaria in adults and children 1.
From the Research
Effectiveness of Prednisone for Treating Urticaria
- The effectiveness of a short course of prednisone for treating urticaria has been studied in several research papers 2, 3, 4, 5, 6.
- A study published in 2003 found that corticosteroid therapy with prednisone can be administered for a few days (7-14) if urticarial symptoms are not controlled by antihistamines and a rapid clinical response is needed 2.
- Another study published in 2010 found that a single short course of prednisone induced remission in nearly 50% of patients with chronic urticaria, and a second course induced remission in a further 9% 3.
- A 2011 study stated that brief corticosteroid bursts may be used as adjunctive treatment for urticaria 4.
- A 2017 study also mentioned that brief corticosteroid bursts may be used as adjunctive treatment for urticaria 5.
- However, a 2024 systematic review 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 6.
Response Rates to Prednisone Treatment
- The response rate to prednisone treatment varies among studies, with one study finding that 47% of patients with antihistamine-resistant chronic urticaria responded to a course of prednisone 3.
- Another study found that nearly 50% of patients with chronic urticaria achieved remission after a single short course of prednisone, and a second course induced remission in a further 9% 3.