Which medications in the drug class Corticosteroids are used in the treatment of Acute Urticaria?

Updated: Mar 21, 2018
  • Author: Henry K Wong, MD, PhD; Chief Editor: Michael A Kaliner, MD  more...
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In instances of acute or chronic urticaria in which antihistamines may fail, even at high doses, or adverse effects may be problematic, mediators other than histamine may be involved. In such situations, corticosteroids may be administered. The current recommendation is to avoid prednisone when possible. If not, then consider the possibility of another disease process (eg, malignancy, mastocytosis, [74] vasculitis). Corticosteroids may also be used in urticarial vasculitis, which usually does not respond to antihistamines.

In refractory cases, a short course of an oral corticosteroid (administered daily for 5-7 d, with or without a taper) or a single dose of a long-acting injectable steroid is not usually associated with long-term sequelae and can be helpful when used for an acute episode of urticaria nonresponsive to antihistamines. [24]

Because of adverse effects of chronic or recurrent use of systemic corticosteroids, the long-term use of these agents should be avoided, when possible. If urticaria is severe and cannot be safely controlled with other medications, low-dose therapy and/or alternate day therapy can be considered.

A large number of preparations are available. Representative examples are prednisolone, methylprednisolone, and prednisone.

Prednisolone (Millipred, Orapred, Pediapred)

Prednisone is a commonly used oral agent that must be metabolized to the active metabolite prednisolone for effect. Conversion may be impaired in liver disease. It is useful in cases that have not responded to traditional antihistamine. For extensive, symptomatic urticaria, a burst of prednisone over 4 days can lead to marked improvement and control of symptoms. Prednisone decreases inflammation by suppressing migration of polymorphonuclear leukocytes and by reversing increased capillary permeability.

Methylprednisolone (Medrol, Depo-Medrol, Solu-Medrol)

Methylprednisolone is used for the treatment of severe urticaria reactions. It reverses increased capillary permeability.

Prednisone (Deltasone, Rayos)

Prednisolone is available in both tablet and liquid forms. It reduces capillary permeability.

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