Prednisone Taper Recommendation for Allergic Urticaria
For allergic urticaria (hives), a short tapering course of oral prednisone starting at 0.5-1 mg/kg/day for 3-7 days followed by a gradual taper over 1-2 weeks is recommended when antihistamines fail to control symptoms. 1, 2
Initial Dosing
- Oral prednisone may shorten the duration of acute urticaria at a dose of 50 mg daily for 3 days in adults, though lower doses are often effective 1
- For severe or widespread hives, prednisone at 0.5-1 mg/kg/day is appropriate until symptoms improve to mild or resolve 2, 3
- Antihistamines should be continued during the corticosteroid course as the primary treatment 4
Recommended Tapering Schedule
- Days 1-5: Full prescribed dose (typically 0.5-1 mg/kg/day) 2
- Days 6-7: Reduce to 75% of original dose 2
- Days 8-9: Reduce to 50% of original dose 2
- Days 10-11: Reduce to 25% of original dose 2
- Day 12: Discontinue 2
Alternative Tapering Approach
For more severe cases requiring longer treatment:
- Start with prescribed dose (0.5-1 mg/kg/day) for 3-7 days 1, 3
- Reduce by 5-10 mg every 1-2 days until reaching 20 mg 1
- Then reduce by 5 mg weekly until reaching 10 mg 1
- Finally, reduce by 2.5 mg weekly until discontinuation 1
Important Considerations
- Long-term oral corticosteroids should not be used in chronic urticaria except in very selected cases under specialist supervision 1, 4
- Brief courses of steroids (3-10 days) can be employed for severe exacerbations but should be an infrequent occurrence 4
- Corticosteroid-related side effects include facial rounding, weight gain, acne, and with prolonged use: osteopenia, diabetes, and hypertension 1
- In a study of antihistamine-resistant urticaria, a short course of prednisone (starting at 25 mg/day for 3 days) induced remission in nearly 50% of patients 5
Treatment Algorithm
- First-line: Second-generation antihistamines (up to 4 times the standard dose) 4, 6
- If inadequate response after 2-4 weeks: Add short course of prednisone with taper as outlined above 1, 2
- For recurrent/chronic cases unresponsive to the above: Consider omalizumab or referral to specialist 4
- Monitor for side effects during treatment, particularly if courses are repeated 1
Special Populations
- For children with urticaria: Prednisone 1-2 mg/kg daily (up to 60 mg/day) with taper over 6-8 weeks to 0.1-0.2 mg/kg daily or 5 mg daily 1
- For pregnant patients: Avoid all antihistamines if possible, especially during the first trimester; if corticosteroids are necessary, consult with an obstetrician 1, 3
Remember that corticosteroids should not be the primary treatment for urticaria but rather an adjunct for severe symptoms when antihistamines fail to provide adequate relief 1, 4.