Efficacy and Safety of Systemic Corticosteroids for Urticaria: A systematic review and meta-analysis of randomized clinical trials.

Acute urticaria Adverse events (harms) Angioedema Chronic urticaria flares/exacerbations GRADE Hives Itch severity Meta-analysis Patient-important outcomes Systematic review Systemic corticosteroids (prednisone, methylprednisolone, prednisolone, dexamethasone) Urticaria activity Wheals (welts) exacerbation flare ups

Journal

The journal of allergy and clinical immunology. In practice
ISSN: 2213-2201
Titre abrégé: J Allergy Clin Immunol Pract
Pays: United States
ID NLM: 101597220

Informations de publication

Date de publication:
18 Apr 2024
Historique:
received: 16 01 2024
revised: 08 04 2024
accepted: 09 04 2024
medline: 21 4 2024
pubmed: 21 4 2024
entrez: 20 4 2024
Statut: aheadofprint

Résumé

Short courses of adjunctive systemic corticosteroids are commonly used to treat acute urticaria and chronic urticaria flares (both with or without mast cell-mediated angioedema), but their benefits and harms are unclear. To evaluate the efficacy and safety of treating acute urticaria or chronic urticaria flares with versus without systemic corticosteroids. We searched MEDLINE, EMBASE, CENTRAL, CNKI, VIP, Wanfang, and CBM databases from inception to July 8, 2023 for randomized controlled trials of treating urticaria with versus without systemic corticosteroids. Paired reviewers independently screened records, extracted data, and appraised risk of bias with the Cochrane 2.0 tool. We did random effects meta-analyses of urticaria activity, itch severity and adverse events. We assessed certainty of the evidence using the GRADE approach. We identified 12 randomized trials enrolling 944 patients. For patients with low or moderate probability (17.5% to 64%) to improve with antihistamines alone, add-on systemic corticosteroids likely improve urticaria activity by a 14% to 15% absolute difference (odds ratio [OR] 2.17, 95%CI 1.43-3.31; Number needed to treat [NNT] 7; Moderate certainty). Among patients with a high chance (95.8%) for urticaria to improve with antihistamines alone, add-on systemic corticosteroids likely improved urticaria activity by a 2.2% absolute difference (NNT, 45; Moderate certainty). Corticosteroids may improve itch severity (OR, 2.44; 95%CI 0.87-6.83; Risk difference, 9%; NNT, 11; Low certainty). Systemic corticosteroids also likely increase adverse events (OR, 2.76; 95%CI 1.00-7.62; Risk difference, 15%; number needed to harm [NNH], 9; Moderate certainty). Systemic corticosteroids for acute urticaria or chronic urticaria exacerbations likely improve urticaria, depending on antihistamine-responsiveness, but also likely increase adverse effects in approximately 15% more.

Sections du résumé

BACKGROUND BACKGROUND
Short courses of adjunctive systemic corticosteroids are commonly used to treat acute urticaria and chronic urticaria flares (both with or without mast cell-mediated angioedema), but their benefits and harms are unclear.
OBJECTIVE OBJECTIVE
To evaluate the efficacy and safety of treating acute urticaria or chronic urticaria flares with versus without systemic corticosteroids.
METHODS METHODS
We searched MEDLINE, EMBASE, CENTRAL, CNKI, VIP, Wanfang, and CBM databases from inception to July 8, 2023 for randomized controlled trials of treating urticaria with versus without systemic corticosteroids. Paired reviewers independently screened records, extracted data, and appraised risk of bias with the Cochrane 2.0 tool. We did random effects meta-analyses of urticaria activity, itch severity and adverse events. We assessed certainty of the evidence using the GRADE approach.
RESULTS RESULTS
We identified 12 randomized trials enrolling 944 patients. For patients with low or moderate probability (17.5% to 64%) to improve with antihistamines alone, add-on systemic corticosteroids likely improve urticaria activity by a 14% to 15% absolute difference (odds ratio [OR] 2.17, 95%CI 1.43-3.31; Number needed to treat [NNT] 7; Moderate certainty). Among patients with a high chance (95.8%) for urticaria to improve with antihistamines alone, add-on systemic corticosteroids likely improved urticaria activity by a 2.2% absolute difference (NNT, 45; Moderate certainty). Corticosteroids may improve itch severity (OR, 2.44; 95%CI 0.87-6.83; Risk difference, 9%; NNT, 11; Low certainty). Systemic corticosteroids also likely increase adverse events (OR, 2.76; 95%CI 1.00-7.62; Risk difference, 15%; number needed to harm [NNH], 9; Moderate certainty).
CONCLUSION CONCLUSIONS
Systemic corticosteroids for acute urticaria or chronic urticaria exacerbations likely improve urticaria, depending on antihistamine-responsiveness, but also likely increase adverse effects in approximately 15% more.

Identifiants

DOI: 10.1016/j.jaip.2024.04.016 PMID: 38642709
pubmed: 38642709
pii: S2213-2198(24)00400-8
doi: 10.1016/j.jaip.2024.04.016
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Auteurs

Xiajing Chu (X)

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Evidence in Allergy Group, McMaster University, Hamilton, ON, Canada.

Jason Wang (J)

Evidence in Allergy Group, McMaster University, Hamilton, ON, Canada.

Leonardo Ologundudu (L)

Evidence in Allergy Group, McMaster University, Hamilton, ON, Canada.

Romina Brignardello-Petersen (R)

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Evidence in Allergy Group, McMaster University, Hamilton, ON, Canada.

Gordon H Guyatt (GH)

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Evidence in Allergy Group, McMaster University, Hamilton, ON, Canada.

Paul Oykhman (P)

Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

Jonathan A Bernstein (JA)

Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA.

Sarbjit S Saini (SS)

Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Lisa A Beck (LA)

Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA.

Susan Waserman (S)

University of Arizona College of Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA.

Joseph Moellman (J)

Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

Dave A Khan (DA)

Department of Internal Medicine, Division of Allergy and Immunology, The University of Texas Southwestern Medical Center, Dallas, TX, USA.

Moshe Ben-Shoshan (M)

Department of Pediatrics, Division of Allergy, Immunology and Dermatology, McGill University, Montreal, QC, Canada.

Diane R Baker (DR)

Department of Dermatology, Oregon Health & Sciences University, Portland, OR, USA.

Eric T Oliver (ET)

Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Javed Sheikh (J)

Department of Clinical Immunology and Allergy, Southern California Permanente Medical Group, Los Angeles, CA, USA.

David Lang (D)

Allergy/Immunology, Cleveland Clinic, Cleveland, OH, USA.

Sameer K Mathur (SK)

Division of Allergy, Pulmonary and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.

Tonya Winders (T)

Global Allergy & Airways Patient Platform, Vienna, Austria.

Sanaz Eftekhari (S)

Asthma and Allergy Foundation of America, Arlington, VA, USA.

Donna D Gardner (DD)

Allergy & Asthma Network, Fairfax, VA, USA.

Lauren Runyon (L)

Department of Internal Medicine, Division of Allergy and Immunology, The University of Texas Southwestern Medical Center, Dallas, TX, USA.

Rachel N Asiniwasis (RN)

Division of Dermatology, University of Saskatchewan, Regina, SK, Canada.

Emily F Cole (EF)

Department of Dermatology, Duke University, Durham, NC, USA.

Jeffrey Chan (J)

Emergency Medicine, Southlake Regional Health Centre, Newmarket, ON, Canada.

Kathryn E Wheeler (KE)

Department of Pediatrics, University of Florida, Gainesville, FL, USA.

Kathryn P Trayes (KP)

Department of Family and Community Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

Paul Tran (P)

University of Arizona College of Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA.

Derek K Chu (DK)

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Evidence in Allergy Group, McMaster University, Hamilton, ON, Canada; Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; The Research Institute of St. Joe's Hamilton, Hamilton, Ontario, Canada. Electronic address: chudk@mcmaster.ca.

Classifications MeSH