Clinical Question

In patients presenting with acute urticaria, is combination antihistamine/corticosteroid treatment more effective than antihistamine alone?

Bottom Line

The combination approach of steroids and antihista-mines offers no added benefit to antihistamines alone for the treatment of simple urticaria. (Level of Evidence = 1b –)

Synopsis

The investigators enrolled 100 adults who presented to an emergency department with a generalized rash for less than one day with fleeting wheals and itching but without angioedema or anaphylaxis. All patients were treated with the antihistamine levocetirizine (Xyzal), 5 mg daily for five days, and they were all randomized, using concealed allocation, to additionally receive placebo or prednisone, 40 mg daily for four days. On follow-up by telephone, 62% of patients treated with antihistamine/prednisone and 76% receiving antihistamine/placebo were asymptomatic (difference not significant). Relapse of urticaria was similar in both groups. The study had 80% power to find a difference of 28 percentage points if a difference existed, and analysis was by intention to treat.

Study design: Randomized controlled trial (double-blinded)

Funding source: Foundation

Setting: Emergency department

Reference: BarniolCDehoursEMalletJHouze-CerfonCHLauqueDCharpentierSLevocetirizine and prednisone are not superior to levocetirizine alone for the treatment of acute urticaria: a randomized double-blind clinical trial. Ann Emerg Med2017;pii:S0196-0644(17)30264-0.