From the Guidelines
Corticosteroids are indicated for acute urticaria to shorten its duration, with a recommended dose of prednisolone 50 mg daily for 3 days in adults. This recommendation is based on the guidelines for evaluation and management of urticaria in adults and children, as outlined in the British Journal of Dermatology 1. The use of oral corticosteroids, such as prednisolone, can effectively reduce the duration of acute urticaria.
Key Points to Consider
- The dose of prednisolone can be adjusted, with lower doses often being effective, but the specific dose of 50 mg daily for 3 days is recommended for adults.
- Parenteral hydrocortisone may be used as an adjunct for severe laryngeal edema and anaphylaxis, but its action is delayed.
- Short tapering courses of oral steroids over 3–4 weeks may be necessary for urticarial vasculitis and severe delayed pressure urticaria.
Important Considerations
- Long-term oral corticosteroids should not be used in chronic urticaria, except in very selected cases under regular specialist supervision, due to the potential for significant side effects.
- The quality of evidence for these recommendations is III, and the strength of recommendation is A, as outlined in the study 1.
Clinical Application
- When prescribing corticosteroids for acute urticaria, it is essential to monitor patients for side effects and taper the dose when discontinuing to prevent rebound symptoms.
- Alternative immunomodulatory therapies should be considered for patients requiring frequent steroid courses.
From the Research
Corticosteroids in Acute Urticaria
- There is limited information available on the use of corticosteroids in acute urticaria, as most studies focus on chronic urticaria.
- However, it can be noted that corticosteroids are sometimes used in severe cases of urticaria, but their use is not well established for acute urticaria specifically 2, 3, 4, 5, 6.
Use of Corticosteroids in Urticaria
- Corticosteroids, such as prednisone, have been shown to be effective in inducing remission in patients with antihistamine-resistant chronic urticaria 5.
- A short course of oral prednisone was found to induce remission in nearly 50% of patients with chronic urticaria, and a second course induced remission in a further 9% 5.
- However, the use of corticosteroids in acute urticaria is not well studied, and more research is needed to determine their effectiveness in this context.
Alternative Treatments for Urticaria
- Other treatments, such as cyclosporine, omalizumab, and immunoglobulin therapy, have been shown to be effective in patients with severe or refractory chronic urticaria 2, 3, 4, 6.
- These treatments may be considered for patients who do not respond to antihistamines or corticosteroids, but their use is typically reserved for severe or refractory cases.