From the Guidelines
For allergic urticaria, a typical prednisone treatment regimen should be limited to short courses, ideally 40-60mg daily for 3-5 days, then tapering down by 5-10mg every 1-2 days until discontinuation, with a total course of 7-14 days, as this approach minimizes side effects while providing relief. This recommendation is based on the most recent and relevant guidelines for the management of urticaria, which emphasize the importance of restricting oral corticosteroids to short courses for severe acute urticaria or angio-oedema affecting the mouth 1.
When prescribing prednisone for allergic urticaria, it is essential to consider the potential side effects, including increased appetite, mood changes, insomnia, and elevated blood sugar. To mitigate these risks, patients should be advised to take the medication in the morning with food to reduce stomach irritation. Additionally, antihistamines should be continued as they work through different mechanisms to control symptoms.
The dosage and duration of prednisone treatment may vary depending on the severity and persistence of symptoms. For severe or persistent cases, consultation with a healthcare provider is necessary to determine the optimal dosage adjustments. After completing the prednisone course, patients should focus on identifying and avoiding triggers and maintain antihistamine therapy as directed by their healthcare provider.
It is crucial to note that while other studies may provide guidance on the management of allergic reactions, the most relevant and recent guidelines for urticaria should take precedence in informing treatment decisions 1. However, these studies do not supersede the recommendations for short-term corticosteroid use in the context of allergic urticaria.
Key considerations for prednisone treatment in allergic urticaria include:
- Restricting treatment to short courses for severe acute urticaria
- Monitoring for potential side effects
- Continuing antihistamine therapy
- Adjusting dosage and duration based on symptom severity and persistence
- Focusing on trigger avoidance and maintenance therapy after completing the prednisone course.
From the Research
Prescription for Prednisone Treatment for Allergic Urticaria
- The effectiveness of corticosteroids, such as prednisone, in treating antihistamine-resistant chronic urticaria is widely accepted, although large studies on their use in this disease are lacking 2.
- A study 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% 2.
- For acute urticaria, a 4-day "burst" course of prednisone added to standard treatment with H1 antihistamines was found to be effective in managing the condition, with significant improvement in symptoms and clinical response 3.
- However, a 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 4.
- The mainstay of treatment for urticaria is avoidance of triggers, if identified, and first-line pharmacotherapy is second-generation H1 antihistamines, which can be titrated to greater than standard doses 5.
- Brief corticosteroid bursts, such as prednisone, may be used as adjunctive treatment for urticaria, and low-dose prednisolone therapy administered for a few months has been found to be effective in treating autoimmune urticaria 5, 6.
- The dosage of prednisone used in studies varied, with one study using 25 mg/day for 3 days 2, and another using 20 mg every 12 hours for 4 days 3.
- The duration of prednisone treatment also varied, with one study using a single short course 2, and another using a few months of low-dose therapy 6.