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Urticaria - Management
How should I treat a first episode of urticaria?
- Treatment is not needed if the episode is mild; acute urticaria is normally self-limiting, and is not serious or infectious.
- If symptomatic treatment is needed:
- Offer a non-sedating antihistamine to control daytime symptoms.
- Consider giving an additional sedating antihistamine at night if the itch is interfering with sleep.
- For severe symptoms:
- Give a short course of oral corticosteroids (e.g. prednisolone 40 mg daily for 3–5 days) in addition to the oral antihistamine.
- If rebound symptoms occur after a short course of corticosteroids seek specialist advice. Repeat courses of steroids are not recommended.
Basis for recommendation
Oral antihistamines:
- Antihistamines (H1-receptor blockers) are the only drugs licensed for use in urticaria.
- In people with chronic urticaria, randomized controlled trials of non-sedating antihistamines have reported improvements in symptoms of itch, weal formation, frequency of exacerbations, and quality of life [Belaich et al, 1990; Breneman et al, 1995; Kaplan et al, 2005; Zuberbier et al, 2006].
- Although the efficacy of antihistamines has only been demonstrated in chronic urticaria, there is a consensus that they are also effective for acute urticaria: urticaria of all types is characterized by histamine release [Grattan et al, 2001; Zuberbier et al, 2006].
Oral corticosteroids:
- Experts recommend that a short course of high-dose oral corticosteroids should be reserved for severe acute urticaria [Grattan et al, 2001].
- Corticosteroids are potent immunosuppressants and can therefore suppress the symptoms of urticaria. However, CKS found only one non-randomized, open study (prednisolone 50 mg daily for 3 days) that examined their use [Zuberbier et al, 1996]. This study found that a 3–day course of oral prednisolone followed by loratadine shortened the duration of acute urticaria compared with loratadine treatment alone.
- In view of the lack of prospective studies of oral corticosteroids for urticaria, CKS recommends a 3–5 day course of oral prednisolone, at the same dosage as used for an acute exacerbation of asthma [SIGN and BTS, 2005].
- CKS does not recommend repeat courses of oral corticosteroids for rebound symptoms because of concerns that this will lead to their long term use, and because of the risk of potential adverse effects.
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