Do you have hives? Hold steroids – American College of Emergency Physicians

Despite the standard use for itching associated with urticaria (commonly known as urticaria), prednisone (a steroid) did not offer additional relief to emergency patients suffering from hives than a placebo, according to a randomized, controlled study with placebo, double-blind, parallel (“Levocetirizine and prednisone are not superior to levocetirizine alone for the treatment of acute urticaria: a double-blind randomized clinical trial”).

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“Prednisone is a strong and excellent drug for certain problems, but it is no better than antihistamine treatment for patients who are itchy with hives,” said lead author Caroline Barniol of the University Hospital Center in Toulouse, France. “The antihistamine levocetirizine alone achieved complete relief of itching in 2 days for 76 percent of patients, with the addition of prednisone, relief scores were actually worse.”

At the 2-day follow-up, 62 percent of patients treated with levocetirizine (an antihistamine) and prednisone had a “itching score” of 0, while 76 percent of those in the placebo group (levocetirizine and placebo). Thirty percent of patients in the prednisone group and 24 percent in the placebo group reported relapses.

Acute urticaria, or urticaria, is a fairly common presentation in the emergency department. Itching is often associated with hives and can interfere with daily activities and sleep. International guidelines published in 2013 indicated that a short course of oral corticosteroids may be useful in reducing the duration of disease for acute hives. Prednisone is commonly prescribed in the emergency department to treat them, along with antihistamines.

“Despite evidence that second-generation H1 antihistamines treat acute urticaria without affecting side effects, many physicians believe that corticosteroids remain the most effective treatment for rapid relief of symptoms,” said Dr. Barniol. “Our results do not support the addition of corticosteroids to antihistamines as first-line treatment of uncomplicated acute urticaria, although short-term corticosteroid therapy does not cause clinically significant toxicity, recurrent or long-term treatment can have deleterious effects.”

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to promoting emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.