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A 4 year old girl presents with an itchy urticarial rash. There were no other symptoms. Her general practitioner has prescribed an oral antihistamine but the rash has persisted. You wonder if there is a role for oral steroids in this otherwise well child.
Structured clinical question
In a child with acute urticaria [patient], does the addition of oral steroids to antihistamines [intervention] lead to more rapid resolution of symptoms [outcome]?
Search strategy and outcome
Cochrane Database of Systematic Reviews using search term “urticaria”: no relevant results.
Medline 1966 to October 2002 using the OVID interface. (“exp urticaria OR urticaria$.mp” AND “exp steroids OR steroid$.mp OR exp adrenal cortex hormones OR corticosteroid$.mp”) LIMIT to [human AND RCT]. Search results – 21 articles, of which two were relevant.
A further search of Medline without the RCT filter and of SUMsearch using search terms “steroids” and “urticaria” yielded no further relevant results.
See table 3.
There are no studies specifically aimed at children with acute urticaria. These limited trials show improvement in symptoms when prednisolone is prescribed, but larger studies are needed. The decision to treat with steroids should be based on the potential benefit of decreasing symptom duration in this often self limiting illness, weighed against the potential adverse effects of therapy. However, no side effects were observed in either study.
CLINICAL BOTTOM LINE
Oral prednisolone added to antihistamines may result in decreased itch and more rapid rash resolution in acute urticaria.