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- Still getting hives while on prednisone

  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. ❿  

Still getting hives while on prednisone. For Hives, A New Study Suggests Many Can Skip The Steroids

 

This site uses cookies. By continuing to browse this site, you are agreeing to our use of cookies. Review our cookies information for more details. She took Benadryl, and 45 minutes later, she took prednisone. 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 body. She went to an urgent care, was given Claritin and Pepcid, and the rash started to resolve. Both she and her PCP are concerned that this rash was related to prednisone, given the timing related to the prednisone dose. I know reactions to steroids are rare, especially oral steroids, but how would you recommend approaching this case? I know there are different classes of steroids, would you consider doing an oral challenge to one of the steroids in a different class, like dexamethasone?

Would you do any testing? I think it is more likely that the patient had both urticaria and angioedema with the urticaria developing after the onset of the angioedema. Was there any likely culprit for the angioedema? Had this happened previously? If this is a one time occurrence, the possibility of an allergic reaction to an ingestant or insect sting would need to be considered.

Corticosteroid allergy is well described but very rare. Most of the reactions have occurred with injectable corticosteroids, most often succinate or semisuccinate salts such as injectable methylprednisolone or hydrocortisone.

A report of 9 patients with suspected corticosteroid sensitivity, confirmed by challenge from a cohort of 64 with suspected allergy, concluded that sensitivity to excipients, such as carboxymethylcellulose or polyethylene glycol, is more likely than corticosteroid allergy 1.

None of the reactions in this series of 64 affected subjects included oral prednisone but rather was dexamethasone, hydrocortisone, methylprednisolone and triamcinolone. Skin testing has been described and was utilized in this report with percutaneous testing concentrations at full strength and intradermal at dilutions. However, skin testing is not validated with corticosteroids and would not be possible with an oral preparation such as prednisone.

I would reassure the patient and the primary care physician that the reaction was not likely a reaction to the corticosteroid. Dexamethasone has the fewest reports of allergy or allergic-like reactions.

I would consider an oral challenge with prednisone, prednisolone or dexamethasone but would not perform skin testing since an oral product is implicated and predictive value is not known. J Allergy Clin Immunol Pract. I hope this information is of help to you and your practice.

All my best. Dennis K. Angioedema with urticaria following oral prednisone Question:.

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Still getting hives while on prednisone.MY APPROACH to the Diagnosis and Treatment of Urticaria (Hives)

    The better news is that whether you take steroids or not, the risks they'll turn life-threatening are exceedingly low. You know, normally we would prescribe steroids in this situation. I would reassure the patient and the primary care physician that the reaction was not likely a reaction to the corticosteroid.

But if you continue to have symptoms or it doesn't seem like it's turning around, then you should be seeking medical advice. She called the study "nicely done," and further evidence that histamine is a key element in the hives allergic reaction, "so it makes sense that if you take an antihistamine, that that would help with blocking the histamine, which is what's really driving that itch.

But, I asked her, doesn't it make sense that if an allergic reaction like hives is an overreaction of the immune system, and steroids ratchet down the immune system, they should be helpful against hives? The steroid "is trying to help decrease that inflammation kind of slowly," she said.

So for patients who may have a bigger presentation, the steroids can be helpful in that way. Vukmir said the study offers more fodder for a discussion between doctors and patients as they consider the options. In the wake of the study, he said, his script might sound like this:. You know, normally we would prescribe steroids in this situation. It's been done for years.

There's a good track record. Some people get a little concerned about steroids. So there is this other alternative: There's a new study that said maybe we don't need to give steroids, in that you don't get better that much more quickly.

And we can try that approach, and I might use a higher dose of the antihistamine. He might also suggest that the patient call him if there's a problem, and that he could still phone the steroid prescription in to the pharmacy. And medicine is always trying to improve, in part by reexamining current medical dogma, as this French study did. I'm leaning toward skipping the steroid, at least at first, if I get another hives attack.

But one lingering concern: The study did find that in one patient among the 50 who got a placebo rather than a steroid, the hives progressed to an anaphylactic allergic reaction.

Vukmir said he wasn't sure the report was a full-fledged anaphylactic reaction, and in any case, there's usually good warning: The classic anaphylactic reaction, he said, typically occurs within 20 minutes, and involves a blood pressure drop or significant breathing problems. 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, medications , but 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, sweating , and 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.

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.

Despite standard use for the itching associated with urticaria commonly known as hivesprednisone 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.

Materials provided by American College of Emergency Physicians. Note: Content may be edited for style and length. Science News. Hold the steroids. ScienceDaily, 3 May American College of Emergency Physicians. Got hives? Retrieved November 21, from www. Print Email Share. Wireless Earphones as Inexpensive Hearing Aids. Unlocking the Power of Our Emotional Memory. Explore More. Food Preservative Enhances Schizophrenia Treatment.

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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. Most of the hives appear within 1 hour after exposure. can use intermittent topical steroids to acute hives along with cold compresses. 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. Urticaria is a disease characterized by development of wheals (hives), angioedema, Acute urticaria is often treated with antihistamines, steroids. Prednisone is commonly prescribed in the emergency department to treat them, along with antihistamines. Should I be seen? But one lingering concern: The study did find that in one patient among the 50 who got a placebo rather than a steroid, the hives progressed to an anaphylactic allergic reaction. If you have any question about this, consult with the patient's primary care physician! Living Well. Warn the patient that you will not be using prednisone long-term even if the prednisone works great!

The baffling, itchy red welts began in early fall, cropping up in odd places: on my torso why would a mosquito bite a spot that wasn't exposed? Every day or two, a new one would appear; some in clusters and others alone; some as small as pimples, but one swelling almost to the size of a ping pong ball.

Finally, I went to urgent care. 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.

He prescribed an over-the-counter antihistamine, Benadryl, and a steroid, prednisone. I knew vaguely that steroids were not-to-be-taken-lightly drugs.

They carry the potential for significant side effects: 'roid rage, blood sugar spikes, long-term risk of infection and bone loss. But this was a "Make it stop! The treatment worked beautifully, ending the itch and beating down the swelling within a day or two. I never did figure out what triggered the hives. Hold The Steroids. The press release about the Annals Of Emergency Medicine study included this:. With the addition of prednisone, the relief scores were actually worse.

Levocetirizine — better known by the brand name Xyzal — is a non-sedating antihistamine that lasts 24 hours. It got federal approval earlier this year to be sold over the counter. So maybe, I wondered, I didn't need to take those slightly scary steroids after all? The French study was small -- just patients with basic hives, no puffiness of face or feet — but high quality: patients were randomly assigned to steroids or placebo, and "blind" to which they got.

On the other hand, hives can be a little scary too: They can — rarely — progress to a potentially life-threatening anaphylactic reaction. So couldn't steroids help prevent that? What does this study mean for the next time you or I see those nasty itchy red bumps breaking out?

First, as always, ask your doctor if you're in any doubt: Is this hives? Should I be seen? Editorializing here, but if you can't send a smartphone photo to your primary care office, something's wrong. Rade Vukmir. Both say the study is unlikely to shift the current standard practice of offering both an antihistamine and a steroid — and often a Pepcid or Zantac as well, which block an additional kind of histamine, Vukmir said, for a " punch.

But each found value in it nonetheless. Hsu Blatman says that for patients with relatively mild cases of hives, the study underscores the option of simply taking antihistamines at home.

But if you continue to have symptoms or it doesn't seem like it's turning around, then you should be seeking medical advice. She called the study "nicely done," and further evidence that histamine is a key element in the hives allergic reaction, "so it makes sense that if you take an antihistamine, that that would help with blocking the histamine, which is what's really driving that itch.

But, I asked her, doesn't it make sense that if an allergic reaction like hives is an overreaction of the immune system, and steroids ratchet down the immune system, they should be helpful against hives? The steroid "is trying to help decrease that inflammation kind of slowly," she said. So for patients who may have a bigger presentation, the steroids can be helpful in that way. Vukmir said the study offers more fodder for a discussion between doctors and patients as they consider the options. In the wake of the study, he said, his script might sound like this:.

You know, normally we would prescribe steroids in this situation. It's been done for years. There's a good track record. Some people get a little concerned about steroids. So there is this other alternative: There's a new study that said maybe we don't need to give steroids, in that you don't get better that much more quickly. And we can try that approach, and I might use a higher dose of the antihistamine. He might also suggest that the patient call him if there's a problem, and that he could still phone the steroid prescription in to the pharmacy.

And medicine is always trying to improve, in part by reexamining current medical dogma, as this French study did. I'm leaning toward skipping the steroid, at least at first, if I get another hives attack. But one lingering concern: The study did find that in one patient among the 50 who got a placebo rather than a steroid, the hives progressed to an anaphylactic allergic reaction.

Vukmir said he wasn't sure the report was a full-fledged anaphylactic reaction, and in any case, there's usually good warning: The classic anaphylactic reaction, he said, typically occurs within 20 minutes, and involves a blood pressure drop or significant breathing problems.

So if you're prone to hives, would you try skipping the steroid yourself? The good news is that hives usually pass on their own anyway — they're "self-limiting," in medical parlance. The better news is that whether you take steroids or not, the risks they'll turn life-threatening are exceedingly low.

And maybe the best news is that in current medical culture, you're likely to have a choice. Skip to main content. Listen Live. It's Boston local news in one concise, fun and informative email Thank you! You can try subscribing here or try again later. Play Listen Live.