What is the recommended dose of Wysolone (Prednisolone) for treating urticaria in adults and pediatric patients?

Recommended Dose of Wysolone (Prednisolone) for Urticaria

For acute severe urticaria in adults, prednisolone 50 mg daily for 3 days is the guideline-recommended regimen, though lower doses are frequently effective and should be considered to minimize corticosteroid exposure. 1, 2

Treatment Algorithm for Urticaria

First-Line Therapy (Always Start Here)

• Begin with second-generation H1 antihistamines (cetirizine, loratadine, desloratadine, fexofenadine, levocetirizine) at standard doses for 2-4 weeks 1
• More than 40% of patients respond to antihistamines alone 1

Second-Line: Dose Escalation

• If inadequate response after 2-4 weeks, increase antihistamine dose up to 4 times the standard dose before considering corticosteroids 1, 3
• Approximately 75% of patients respond to antihistamine dose escalation 1

Third-Line: Short-Course Corticosteroids (Only for Severe Acute Cases)

Adult Dosing:

• Prednisolone 50 mg daily for 3 days for severe acute urticaria or angioedema affecting the mouth 4, 1, 2
• Lower doses (25 mg daily for 3 days) are frequently effective and should be considered first to minimize exposure 1, 2, 5
• Maximum duration: 3-10 days for severe acute exacerbations 1, 2, 3

Pediatric Dosing:

• Prednisolone 1-2 mg/kg/day in divided doses for short courses (3-10 days maximum) 6
• For children with asthma-related urticaria: 1-2 mg/kg/day until symptoms resolve, typically 3-10 days 6

Critical Contraindications and Warnings

Absolute Contraindication

• Long-term oral corticosteroids should NOT be used in chronic spontaneous urticaria (Strength of recommendation A) 4, 1, 2
• This is a firm contraindication due to cumulative toxicity and unfavorable risk-benefit ratio 1, 2
• Chronic corticosteroid use is associated with dose- and time-dependent toxicity 3

When Corticosteroids Should Be Avoided

• Never use corticosteroids as first-line treatment when antihistamines are sufficient 1
• Never continue corticosteroids beyond 3-10 days 1, 2
• A recent 2021 randomized controlled trial found that adding IV dexamethasone to antihistamines did not improve pruritus scores at 60 minutes, and oral corticosteroids for 5 days were associated with more persistent urticaria activity at 1-week and 1-month follow-up 7

Common Pitfalls to Avoid

1. Using corticosteroids too early: Always optimize antihistamine therapy first (standard dose, then up to 4x dose) before adding corticosteroids 1, 3

2. Prolonged corticosteroid courses: The evidence for benefit beyond 3-10 days is questionable, while cumulative toxicity is well-established 1, 3

3. Chronic corticosteroids for chronic urticaria: This is the most critical error—instead, escalate to omalizumab (300 mg subcutaneously every 4 weeks) or cyclosporine (4 mg/kg daily) for antihistamine-refractory chronic urticaria 1, 2, 3

4. Ignoring lower effective doses: Starting with 25 mg prednisolone daily instead of 50 mg can be equally effective while minimizing exposure 5

Refractory Cases (After Failed Antihistamine Escalation)

For chronic urticaria unresponsive to high-dose antihistamines:

• Omalizumab 300 mg subcutaneously every 4 weeks is effective in 70% of antihistamine-refractory patients 3, 8
• Cyclosporine 4 mg/kg daily for up to 2 months is effective in approximately two-thirds of severe autoimmune urticaria cases 4, 2, 3
• H2 antihistamines and leukotriene antagonists add minimal benefit and are no longer strongly recommended 3, 8

Special Considerations

Emergency Situations

• For anaphylaxis or severe laryngeal angioedema: Epinephrine 0.5 mL of 1:1000 (500 µg) intramuscularly immediately 1
• Corticosteroids are adjunctive only and do not replace epinephrine in true emergencies 1

Pregnancy

• Avoid corticosteroids if possible, especially in first trimester 2
• If necessary, use lowest effective dose for shortest duration 2