Outpatient management of acute urticaria: the role of prednisone.
OBJECTIVE
To evaluate the efficacy of a 4-day "burst" course of prednisone added to standard treatment with H1 antihistamines for the management of acute urticaria in outpatients.


METHODS
Prospective, randomized, double-blinded, clinical trial.


METHODS
Emergency department of an urban tertiary care teaching hospital.


METHODS
Adult patients with urticarial rash of no more than 24 hours' duration, regardless of cause. Patients were excluded if they manifested wheezing, stridor, or angioedema or if they had taken antihistamines or glucocorticoids within 5 days of arrival at the ED. Patients also were excluded if there was a history of diabetes or active peptic ulcer disease.


METHODS
All patients were asked to evaluate the severity of pruritus ("itch score") on a 10-cm visual analog scale. Patients were then given diphenhydramine, 50 mg intramuscularly, and discharged home on a regimen of hydroxyzine, 25 mg orally, every 4 to 8 hours for pruritus, plus either prednisone, 20 mg, or placebo orally every 12 hours for 4 days. Patients' conditions were reassessed clinically, with itch score calculated again 2 days later, and again at 5 days by telephone.


RESULTS
Forty-three patients were enrolled; 24 received prednisone and 19 received placebo. The two groups had similar itch scores at enrollment (prednisone, 8.1 +/- 1.7; placebo, 7.4 +/- 2.1, P = .25 [ANOVA]), but at 2- and 5-day follow-up the prednisone group had significantly lower itch scores (1.3 +/- 1.3 and .0 +/- .0 versus 4.4 +/- 2.2 and 1.6 +/- 1.0, respectively; P < .0001 [ANCOVA] at each interval) and greater clinical improvement in rash. Response did not correlate with age, sex, or identification of an allergen. No adverse effects were noted in either group.


CONCLUSIONS
The addition of a prednisone burst improves the symptomatic and clinical response of acute urticaria to antihistamines. Patients' conditions improved more quickly and more completely when prednisone was administered, without any apparent adverse effects.
D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000982:Antipruritics / Q000627:therapeutic use; D004155:Diphenhydramine / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D005260:Female; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D006919:Hydroxyzine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D014581:Urticaria / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents; D000982:Antipruritics; D006634:Histamine H1 Antagonists; D006919:Hydroxyzine; D004155:Diphenhydramine; D011241:Prednisone