Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Adding Prednisone for Treating Acute Urticaria

Ann Emerg Med; ePub 2017 May 3; Barniol, et al

The addition of prednisone did not improve the symptomatic and clinical response of acute urticarial to levocetirizine, a recent study found. The randomized, double-blind clinical trial included patients aged ≥18 years and with acute urticarial of no more than 24 hour durations. In addition to levocetirizine (5 mg orally for 5 days), patients were assigned to receive prednisone (40 mg orally for 4 days), or placebo. Primary endpoint was itching relief 2 days after emergency department visit (rating of numeric scale 0 to 10). Secondary endpoints were rash resolution, relapses, and adverse events. Researchers found:

  • 100 patients were included, 50 in each group.
  • At 2-day follow-up, 62% of patients in the prednisone group had an itch score of 0 vs 76% in the placebo group.
  • 30% of patients in the prednisone group and 24% in the placebo group reported relapses.
  • Mild adverse events were reported by 12% of patients in the prednisone group and 14% in the placebo group.


Barniol C, Dehours E, Mallet J, Houze-Cerfon C-H, Lauque D, Charpentier S. Levocetirizone and prednisone are not superior to levocetirizine alone for the treatment of acute urticarial: A randomized double-blind clinical trial. [Published online ahead of print May 3, 2017]. Ann Emerg Med. doi:10.1016/j.annemergmed.2017.03.006.


Urticaria, or hives, without wheezing or angioedema is a common presenting condition in primary care practices and is considered a histamine-induced reaction. While it is acknowledged that the primary treatment is with an antihistamine, some sources suggest that addition of oral corticosteroids be considered as well.1 The problem with this recommendation is that steroids may then become overused in the treatment of urticaria without much benefit. As we reviewed just a few weeks ago, even short courses of oral steroids may have significant side effects.2 The present study convincingly demonstrates that oral corticosteroids add little to second generation antihistamines in the treatment of urticarial without wheezing or angioedema. —Neil Skolnik, MD

  1. Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA(2) LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014;69:868-887. doi:10.1111/all.12313.
  2. Waljee AK, Rogers AM, Lin P, et al. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ. 2017;357:j1415.

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