Tips for diagnosing, treating urticaria.MY APPROACH to the Diagnosis and Treatment of Urticaria (Hives)

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- Outpatient management of acute urticaria: the role of prednisone

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Conclusion: The addition of a prednisone burst improves the symptomatic and clinical response of acute urticaria to antihistamines. Patients' conditions. Urticaria – also known as hives or nettle rash – is a raised, systemic steroids are not recommended but short courses of prednisolone (at a dose up to. For patients unresponsive to antihistamines or a combination of medications, oral prednisone 60 mg tapered over 2 weeks will often give. ❿

- Prednisone taper urticaria

Metrics details. To evaluate the efficacy of a 5 day short course of oral prednisolone when added with levocetirizine for management of acute urticaria. Patients were then given oral prednisolone 30 mg for 5 days and tablet levocetirizine 5 mg twice daily for 6 weeks and only levocetirizine tablet 5 mg twice daily for 6 weeks. The two groups had similar UAS at enrollment prednisolone, 4. Response did not correlate with age, sex, or identification of an allergen.

No adverse effects were noted in levocetirizine group. In Prednisolone group two patients complained of gastritis. At the end of 6 weeks, 3 patients from the steroid group and 8 patients from the levocetirizine group continued to get urticarial wheals. The addition of a prednisolone short course improves the symptomatic and clinical response of acute urticaria to antihistamines.

Patients with steroids improved more quickly and completely without major adverse effects. You can also search for this author in PubMed Google Scholar.

This article is published under license to BioMed Central Ltd. Reprints and Permissions. Godse, K. The role of prednisolone in acute urticaria management. Clin Transl Allergy 5 Suppl 1O8 Download citation. Published : 11 March Anyone you share the following link with will be able to read this content:.

Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Volume 5 Supplement 1. Aim To evaluate the efficacy of a 5 day short course of oral prednisolone when added with levocetirizine for management of acute urticaria. Materials and methods Prospective, randomized clinical trial was carried out in a teaching hospital. All patients were asked to evaluate the severity of pruritus on urticarial activity score UAS.

Results 49 patients were enrolled; 24 patients received prednisolone with Levocetirizine and 25 received only Levocetirizine. Conclusion At the end of 6 weeks, 3 patients from the steroid group and 8 patients from the levocetirizine group continued to get urticarial wheals. About this article. Cite this article Godse, K. Copy to clipboard.

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- Prednisone taper urticaria

To evaluate the efficacy of a 5 day short course of oral prednisolone when added with levocetirizine for management of acute urticaria. About this article.

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Please update your settings with a valid address before to continue using PracticeUpdate. Close Back. Sign in. Join now. Follow us on:. Search PracticeUpdate Cancel. Additional Info. The role of prednisolone in acute urticaria management. Clin Transl Allergy 5 Suppl 1 , O8 Download citation. Published : 11 March Anyone you share the following link with will be able to read this content:.

Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Interventions: All patients were asked to evaluate the severity of pruritus "itch score" on a 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. Researchers are conducting studies on second generation anti IgE antibodies, according to Dr.

English, but they are still in clinical trials. English says one trend in the treatment of urticaria patients is for the dermatology practice to perform radioallergosorbent RAST IgE testing looking for food, mold, grass, tree, mite, animal dander and other allergens. Tips for diagnosing, treating urticaria. January 18, Lisette Hilton. Acute urticaria generally is very pruritic and usually does not have a burning sensation.

Autoimmune bullous disorders are also a possibility, according to Dr.

All rights reserved. Physician assistants PAs and nurse practitioners NPs in dermatology often encounter patients with urticaria and need to know how to distinguish acute and chronic conditions. Participate in this forum. Physician assistants PAs and nurse practitioners NPs in dermatology need to be able to distinguish acute from chronic urticaria and look into what is causing the hives and consider urticaria-like eruptions as differentials, according to Joseph C English III, M.

Angioedema tends to be a deeper swelling that affects the eyes and mouth and, in some cases, may cause laryngeal edema with airway compromise. If it associated with a drop of systolic blood pressure, anaphylaxis is occurring.

English says. The standard first-line treatment for acute urticaria is an oral antihistamine-the non-sedating type during the day and sedating during the night. For angioedema and severe cases in which patients experience airway compromise in the office, dermatology providers might administer injectable epinephrine before sending patients to the emergency room. Urticaria patients who have experienced angioedema or anaphylaxis need to have personal injectable epinephrine to carry with them, he says.

The lesions of chronic urticaria look like those in acute hives. But in chronic urticaria patients have lesions recurring and persisting for six to eight weeks or more. English says his workup for chronic urticaria patients includes checking for thyroid antibodies and thyroid function. English recommends a biopsy and direct immunofluorescence to rule out other urticarial dermatoses: urticarial vasculitis, urticarial dermatitis dermal hypersensitivity reactionor prodromal or urticarial bullous pemphigoid, especially if lesions are not migratory.

So, in patients with chronic urticaria who have bone pain symptoms, Dr. English will check a serum immunofixation electrophoresis and serum free light-chain just to see if they have an abnormal protein. Most insurance companies require you to fail a primary line of suppression before you get to the more expensive line of biologics. English says the biologic he usually prescribes for urticaria is omalizumab, a monoclonal anti immunoglobulin E IgE antibody.

He cites a metanalysis published January in JAMA Dermatology looking at benefits and harms of omalizumab treatment in adolescent and adult chronic idiopathic urticaria. For patients resistant to omalizumab, Dr. An important question to ask when assessing chronic hives is: Are the lesions fixed or do they migrate? They like to be fixed and stay in the same place longer than 24 hours.

One is in the second trimester patients can get pemphigoid gestationis; later in the third trimester they can get polymorphic eruption of pregnancy. More biologic options might be on the horizon for these patients. Researchers are conducting studies on second generation anti IgE antibodies, according to Dr. English, but they are still in clinical trials.

English says one trend in the treatment of urticaria patients is for the dermatology practice to perform radioallergosorbent RAST IgE testing looking for food, mold, grass, tree, mite, animal dander and other allergens.

Tips for diagnosing, treating urticaria. January 18, Lisette Hilton. Acute urticaria generally is very pruritic and usually does not have a burning sensation. Autoimmune bullous disorders are also a possibility, according to Dr.

Conclusion: The addition of a prednisone burst improves the symptomatic and clinical response of acute urticaria to antihistamines. Patients' conditions. The first group received levocetirizine (5 mg) twice a day and prednisolone ( mg) twice a day for the first 5 days. Prednisolone was given in the dose of. If the prednisone is stopped too soon when prescribed for certain types of rashes, such as poison ivy, a rebound rash may occur. This is why it is better to. Urticaria – also known as hives or nettle rash – is a raised, systemic steroids are not recommended but short courses of prednisolone (at a dose up to. In adults, mg daily of prednisone for 5 days is a reasonable therapeutic regimen. In children, the treatment is 1 mg/kg/d for 5 days. Property Value Status.

The diagnosis and treatment of urticaria hives can be very rewarding, and quite frustrating! Fortunately, the basic science underlying hiving has led to increasingly useful drugs helping to the point that physicians can help the vast majority of patients. Hives wheals appear as swollen, pale or red, mm papules and larger wheals that can be confluent. They appear rapidly and resolve within 24 hours, with hives coming up in new areas over time. The vast majority of hives are associated with itching and dermatographism stroking the skin leaves a linear wheal Hives can appear anywhere on the body and are sometimes associated with angioedema deep localized swelling, usually on the lips, hands, feet, or genitals.

In very rare cases, swelling of the throat or wheezing leads to respiratory compromise. In some cases the GI tract is involved, causing vomiting and diarrhea. Histamine release is at the center of the mechanism of hives and angioedema.

This causes blood plasma to leak from small vessels. Of course, bradykinin, kallikrein, and other vasoactive substances released from mast cells and basophils are also components of a very complex mechanism. The trigger for histamine release is often allergic foods, insect bites, medications , but sometimes physical factors cause histamine release, including sunlight, pressure, cold, and scratching.

For patients with urticaria that has lasted just a few weeks, no work-up is indicated beyond a good history. The majority of patients will have their hives controlled with treatment, and their hives will resolve if the cause is identified by history food, latex, medication [most often aspirin, non-steroidal anti-inflammatory drugs, penicillin, sulfa, and ACE inhibitors], inhaled allergens [eg, pet dander, pollen], physical causes, etc and eliminated or the hives may disappear on their own even when no cause can be found.

In fact, no cause is found in the vast majority of patients. In patients with urticaria that persists longer than 6 weeks, a referral to primary care for a physical examination and blood work searching for signs of an occult infection, including hepatitis, intestinal parasite, autoimmune disease, or internal malignancy, is indicated.

Physical urticaria consists of hives caused by direct physical stimulation of the skin, for example, cold, heat, sun exposure, vibration, pressure, sweating , and exercise. The hives usually occur right where the skin was stimulated and rarely appear elsewhere. Most of the hives appear within 1 hour after exposure. In patients with urticaria that last longer than 24 hours, a skin biopsy may be helpful to exclude urticarial vasculitis, urticarial pemphigoid, and other conditions that might mimic hives.

The best treatment for hives and angioedema is to identify and remove the trigger whether that be a drug, food, or physical factor. Antihistamines targeting H1 are the mainstay of treatment and include older drugs such as diphenhydramine and hydroxyzine mg at bedtime are useful, but can be quite sedating; hence, their use at bedtime. Some special tips:. Push the dose. Except in patients with a history of heart arrhythmias, concomitant drugs that elevate the Q-T interval, the non-sedating antihistamines can be given safely at double the FDA approved dose.

If you have any question about this, consult with the patient's primary care physician! Consider combining antihistamines from different classes. Taking a non-sedating antihistamine in the morning and a sedating antihistamine at bedtime can help many patients.

Consider doxepin mg at bedtime. This is the strongest anti-histamine known to mankind and often helps when other drugs do not. It can be quite sedating, however. Although most experts believe topical steroids are not useful, I have found that patients with dermatographism can use intermittent topical steroids to acute hives along with cold compresses for quick relief of itching to help them avoid scratching that aggravates their condition.

Of course, careful consideration must be given to underlying diabetes, high blood pressure, and a multitude of other steroid side effects. Warn the patient that you will not be using prednisone long-term even if the prednisone works great! Property Value Status. We have detected that you are using an Ad Blocker. PracticeUpdate is free to end users but we rely on advertising to fund our site. Please consider supporting PracticeUpdate by whitelisting us in your ad blocker.

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