In patients presenting with acute urticaria, is combination antihistamine/corticosteroid treatment more effective than antihistamine alone?

The belt-and-suspenders approach of steroids and antihistamines offers no added benefit to antihistamines alone for the treatment of simple urticaria. (LOE = 1b-)

Barniol C, Dehours E, Mallet J, Houze-Cerfon CH, Lauque D, Charpentier S. Levocetirizine and prednisone are not superior to levocetirizine alone for the treatment of acute urticaria: a randomized double-blind clinical trial. Ann Emerg Med 2017;pii:S0196-0644(17)30264-0.  [PMID:28476259]

Randomized controlled trial (double-blinded)

Foundation

Emergency department

The investigators enrolled 100 adults who presented to an emergency department with a generalized rash for less than a day with fleeting wheals and itching but without angioedema or anaphylaxis. All patients were treated with the antihistamine levocetirizine (Xyzal, Levazyr) 5 mg daily for 5 days, and they were all randomized, using concealed allocation, to additionally receive placebo or prednisone 40 mg daily for 4 days. On follow-up by telephone, 62% of patients treated with antihistamine/prednisone and 76% receiving antihistamine/placebo were asymptomatic (difference not significant). Relapse of urticaria was similar in both groups. The study had 80% power to find a difference of 28 percentage points if a difference existed, and analysis was by intention to treat.