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Adding Corticosteroids to Hives Treatment

A corticosteroid should be added to antihistamine therapy for the first-line treatment of patients who present to the emergency department with acute urticaria.

a. true

b. false

Answer: b

The unbearable itchiness of acute urticaria (hives) disturbs routine life activities and keeps sufferers awake at night, so it’s no surprise that the skin condition accounts for up to 35% of dermatologic conditions that send patients to the emergency department (ED). But what’s the best way to provide patients with sweet relief?

To find out, researchers gave 50 suffering patients levocetirizine 5 mg administered orally for 5 days and added prednisone 40 mg orally for 4 days to the levocetirizine therapy for another 50 patients (Annals of Emergency Medicine. doi:10.1016/j.annemergmed.2017.03.006).

Both treatment options proved effective: Levocetirizine alone eliminated the itching within 2 days in 76% of treated patients, while adding prednisone to the therapy provided relief in 62% of the patients. According to the study, 30% of patients treated with the steroid suffered a relapse, compared with 24% of patients treated with levocetirizine alone. The researchers noted that 14% of patients in both groups experienced mild adverse effects, which included fatigue, sedation, insomnia, and dyspepsia.

The results suggested that adding a corticosteroid to antihistamine therapy for acute urticaria appears unnecessary, according to study author Dr. Dominique Lauque, a professor of medicine at the University of Toulouse III in France.

She added that short-term treatment with corticosteroids does not cause clinically significant toxicity, but recurrent or long-term treatment may have deleterious effects — including weight gain, increased risk of infection, increased blood pressure, elevated blood sugar levels, insomnia, and osteoporosis — especially in patients with comorbidities such as diabetes or immunodepression.

The management of hives can be limited to avoidance of the allergen, when it can be identified, and to symptomatic treatment with H1 antihistamines, noted Dr. Lauque. Refractory cases must be referred to a dermatologist or allergist for investigations and diagnostic measures, she added.

—Dan Cook

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