MY APPROACH to the Diagnosis and Treatment of Urticaria (Hives) | PracticeUpdate.For Hives, A New Study Suggests Many Can Skip The Steroids | WBUR News

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Angioedema with urticaria following oral prednisone

  Urticaria is a disease characterized by development of wheals (hives), angioedema, Acute urticaria is often treated with antihistamines, steroids. Despite standard use for the itching associated with urticaria (commonly known as hives), prednisone (a steroid) offered no additional. Twenty minutes after this, she broke out in what she describes as large blotches that started on her arms. The rash then progressed to her whole. ❿  

Got hives? Hold the steroids -- ScienceDaily

 

Despite standard use for the itching associated with urticaria commonly known as hives , prednisone a steroid offered no additional relief to emergency patients suffering from hives than a placebo did, according to a randomized, placebo-controlled, double-blind, parallel-group study published online yesterday in Annals of Emergency Medicine "Levocetirizine and Prednisone Are Not Superior to Levocetirizine Alone for the Treatment of Acute Urticaria: A Randomized Double-Blind Clinical Trial".

With the addition of prednisone, the relief scores were actually worse. At 2-day follow-up, 62 percent of patients treated with levocetirizine an antihistamine and prednisone had an "itch score" of 0, while 76 percent of those in the placebo group levocetirizine and placebo had an itch score of 0. Thirty percent of patients in the prednisone group and 24 percent in the placebo group reported relapses.

Acute urticaria, or hives, is a fairly common presentation in the emergency department. Itching is frequently associated with hives and can interfere with daily activities and sleep. International guidelines published in stated that a short course of oral corticosteroids may be helpful to reduce disease duration for acute hives. Prednisone is commonly prescribed in the emergency department to treat them, along with antihistamines. Even if short-term treatment with corticosteroids does not cause clinically significant toxicity, recurrent or long-term treatment may have deleterious effects.

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- Got Hives? Hold the Steroids

    In patients with urticaria that persists longer than 6 weeks, a referral to primary care for a physical examination and blood work searching for signs of an occult infection, including hepatitis, intestinal parasite, autoimmune disease, or internal malignancy, is indicated. American College of Emergency Physicians. Close Back. Consider doxepin mg at bedtime. He prescribed an over-the-counter antihistamine, Benadryl, and a steroid, prednisone.

If any of these products last or get worse, tell your nasal or pharmacist promptly. You may need to get smaller amounts of the drug or use it less often. Field your doctor or other for more details. If your condition has directed you to use this system, remember that your doctor has judged that the treatment to you is greater than the risk of side effects.

The diagnosis and treatment of urticaria hives can be very rewarding, and quite frustrating! Fortunately, the basic science underlying hiving has led to increasingly useful drugs helping to the point that physicians can help the vast majority of patients.

Hives wheals appear as swollen, pale or red, mm papules and larger wheals that can be confluent. They appear rapidly and resolve within 24 hours, with hives coming up in new areas over time. The vast majority of hives are associated with itching and dermatographism stroking the skin leaves a linear wheal Hives can appear anywhere on the body and are sometimes associated with angioedema deep localized swelling, usually on the lips, hands, feet, or genitals. In very rare cases, swelling of the throat or wheezing leads to respiratory compromise.

In some cases the GI tract is involved, causing vomiting and diarrhea. Histamine release is at the center of the mechanism of hives and angioedema. This causes blood plasma to leak from small vessels. Of course, bradykinin, kallikrein, and other vasoactive substances released from mast cells and basophils are also components of a very complex mechanism. The trigger for histamine release is often allergic foods, insect bites, medicationsbut sometimes physical factors cause histamine release, including sunlight, pressure, cold, and scratching.

For patients with urticaria that has lasted just a few weeks, no work-up is indicated beyond a good history. The majority of patients will have their hives controlled with treatment, and their hives will resolve if the cause is identified by history food, latex, medication [most often aspirin, non-steroidal anti-inflammatory drugs, penicillin, sulfa, and ACE inhibitors], inhaled allergens [eg, pet dander, pollen], physical causes, etc and eliminated or the hives may disappear on their own even when no cause can be found.

In fact, no cause is found in the vast majority of patients. In patients with urticaria that persists longer than 6 weeks, a referral to primary care for a physical examination and blood work searching for signs of an occult infection, including hepatitis, intestinal parasite, autoimmune disease, or internal malignancy, is indicated. Physical urticaria consists of hives caused by direct physical stimulation of the skin, for example, cold, heat, sun exposure, vibration, pressure, sweatingand exercise.

The hives usually occur right where the skin was stimulated and rarely appear elsewhere. Most of the hives appear within 1 hour after exposure. In patients with urticaria that last longer than 24 hours, a skin biopsy may be helpful to exclude urticarial vasculitis, urticarial pemphigoid, and other conditions that might mimic hives.

The best treatment for hives and angioedema is to identify and remove the trigger whether that be a drug, food, or physical factor.

Antihistamines targeting H1 are the mainstay of treatment and include older drugs such as diphenhydramine and hydroxyzine mg at bedtime are useful, but can be quite sedating; hence, their use at bedtime. Some special tips:. Push the dose. Except in patients with a history of heart arrhythmias, concomitant drugs that elevate the Q-T interval, the non-sedating antihistamines can be given safely at double the FDA approved dose.

If you have any question about this, consult with the patient's primary care physician! Consider combining antihistamines from different classes. Taking a non-sedating antihistamine in the morning and a sedating antihistamine at bedtime can help many patients. Consider doxepin mg at bedtime. This is the strongest anti-histamine known to mankind and often helps when other drugs do not. It can be quite sedating, however. Although most experts believe topical steroids are not useful, I have found that patients with dermatographism can use intermittent topical steroids to acute hives along with cold compresses for quick relief of itching to help them avoid scratching that aggravates their condition.

Of course, careful consideration must be given to underlying diabetes, high blood pressure, and a multitude of other steroid side effects. Warn the patient that you will not be using prednisone long-term even if the prednisone works great!

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Prednisone will calm down hives in most cases, but it can have severe side effects if taken continuously for months or years. Dramatic and. Despite standard use for the itching associated with urticaria (commonly known as hives), prednisone (a steroid) offered no additional relief to. I still get breakthrough hives on this. I have assumed it is autoimmune. I would not recommend long term use of Benadryl especially since it. Note that these pictures were taken while on prednisone. Note that she had a mid-treatment flare after having cantaloupe and Boar's Head. Prednisone will calm down hives in most cases, but it can have severe side effects if taken continuously for months or years. Dramatic and. It took a seasoned doctor about 10 seconds to diagnose me with hives: the often-mysterious allergic reaction that affects about one-fifth of us at some time in our lives.

With the addition of prednisone, the relief scores were actually worse. Thirty percent of patients in the prednisone group and 24 percent in the placebo group reported relapses. Acute urticaria, or hives, is a fairly common presentation in the emergency department. Itching is frequently associated with hives and can interfere with daily activities and sleep. International guidelines published in stated that a short course of oral corticosteroids may be helpful to reduce disease duration for acute hives.

Prednisone is commonly prescribed in the emergency department to treat them, along with antihistamines. Even if short-term treatment with corticosteroids does not cause clinically significant toxicity, recurrent or long-term treatment may have deleterious effects.

Annals of Emergency Medicine is one of the peer-reviewed scientific journal for the American College of Emergency Physicians ACEP , the national medical society representing emergency medicine.

Annals of Emergency Medicine is the largest and most frequently cited circulation peer-reviewed journal in emergency medicine and publishes original research, clinical reports, opinion, and educational information related to the practice, teaching, and research of emergency medicine.

For further information: Steve Arnoff sarnoff acep. American College of Emergency Physicians. About Us. Got Hives? Hold the Steroids May 3, Related Articles. Five Questions with Dr. Claudette Rodriguez.