Steroid Treatment Adds No Benefit to Antihistamines for Acute Hives


Am Fam Physician. 2017 Sep 15;96(6):399-406.

Clinical Question

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

Bottom Line

The combination approach of steroids and antihista-mines offers no added benefit to antihistamines alone for the treatment of simple urticaria. (Level of Evidence = 1b –)


The investigators enrolled 100 adults who presented to an emergency department with a generalized rash for less than one day with fleeting wheals and itching but without angioedema or anaphylaxis. All patients were treated with the antihistamine levocetirizine (Xyzal), 5 mg daily for five days, and they were all randomized, using concealed allocation, to additionally receive placebo or prednisone, 40 mg daily for four 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.

Study design: Randomized controlled trial (double-blinded)

Funding source: Foundation

Setting: Emergency department

Reference: 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.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

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This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.



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