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Oral corticosteroids in acute urticaria
  1. M Poon, Paediatric Registrar,
  2. C Reid, Registrar
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jonesman.ac.uk

    Abstract

    A short cut review was carried out to establish whether the addition of oral corticosteroids to antihistamines leads to a more rapid resolution of urticaria. Thirty nine papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by M Poon, Paediatric RegistrarChecked by C Reid, Registrar

    Clinical scenario

    A 4 year old girl presents to the emergency department with an urticarial rash. Her general practitioner has prescribed an oral antihistamine but the rash has persisted. You wonder if there is a role for oral corticosteroids in this otherwise well child.

    Three part question

    In a [child with acute urticaria] does the [addition of oral corticosteroids to antihistamines] lead to [more rapid resolution of symptoms].

    Search strategy

    Cochrane Database of Systematic Reviews Issue 3, 2003. Medline 1966-10/03 using the OVID interface. Cochrane: ‘urticaria’ Medline: [exp urticaria OR urticaria$.mp] AND [exp steroids OR steroid$.mp OR exp adrenal cortex hormones OR corticosteroid$.mp] AND [Randomized Controlled Trial.pt OR Controlled Clinical Trial.pt] LIMIT to human.

    Search outcome

    Cochrane Database of Sytematic Reviews—no relevant results. Medline search results—39 articles, of which two were relevant (table 3).

    Table 3

    Comment(s)

    There are no studies specifically aimed at children with acute urticaria. These limited trials demonstrate improvement in symptoms when prednisolone is prescribed, but larger studies are needed.

    CLINICAL BOTTOM LINE

    In patients presenting to the emergency department with acute uricaria, the addition of oral prednisolone to an antihistamine results in decreased itch and more rapid rash resolution.

    Report by M Poon, Paediatric RegistrarChecked by C Reid, Registrar

    References

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