In acute urticaria, adding prednisone to levocetirizine offers no additional benefit to patients compared to levocetirizine alone, according to a new study published in Annals of Emergency Medicine.

Researchers from Centre Hospitalier Universitaire, Toulouse, France conducted a double-blind randomized trial in the emergency department of 100 patients who had acute urticaria for <24 hours duration.

Patients received either levocetirizine 5mg daily for 5 days and prednisone 40mg for 4 days (n=50) or levocetirizine 5mg daily plus placebo (n=50). The primary endpoint was itching relief two days after the emergency department visit.

Results showed that the placebo group actually had a greater reduction in itch score, with 76% of this group having an itch score of 0 compared to 62% of patients in the prednisone group (95% CI; –31% to 4%). Additionally, more patients in the prednisone group reported relapses than the placebo group, at 30% versus 24%, respectively (95% CI; –23% to 11%).  

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The results of this study conflict with two previous studies which demonstrated that adding corticosteroids to antihistamines could be beneficial for acute urticaria. However, one of these studies involved first-generation antihistamines (which may be less potent) and the other was not randomized or carried out in an emergency department setting.

“Despite the evidence that second-generation H1-antihistamines treat acute urticaria without disturbing side effects, many physicians believe that corticosteroids are still the most effective treatment to obtain rapid symptom relief,” said lead author of the study Caroline Barniol, MD, “Our results do not support the addition of corticosteroid to antihistamines as a first-line treatment of uncomplicated acute hives. Even if short-term treatment with corticosteroids does not cause clinically significant toxicity, recurrent or long-term treatment may have deleterious effects.” 

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