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Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!
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March 4, 2019 at 9:13 pm
There are surprisingly few trials of short steroid bursts in the treatment of acute urticaria. Two early studies (Pollack CV et al Ann Emerg Med 1995;26(5):547 and Zuberbier T et al Acta Derm Venereol 1996;76(4):295 support quicker resolution of hives and itching with a 3-4 day burst of prednisone or prednisolone. However, a more recent randomized double-blind clinical trial (Barniol C et al Ann Emerg Med 2018;71(1):125) did not show any statistically significant difference, although the 95% confidence interval was consistent with a possibly clinically significantly higher proportion of patients with an itch score of zero at 2 day follow-up in those receiving prednisone for 4 days. These were not studies of children.