Topical corticosteroids for hives and itch (urticaria): systematic review and Bayesian meta-analysis of randomized trials.

GRADE adverse events hives itch severity meta-analysis patient-important outcome systematic review topical corticosteroids urticaria urticaria activity wheal size wheals

Journal

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
ISSN: 1534-4436
Titre abrégé: Ann Allergy Asthma Immunol
Pays: United States
ID NLM: 9503580

Informations de publication

Date de publication:
18 Jun 2024
Historique:
received: 26 04 2024
revised: 02 06 2024
accepted: 04 06 2024
medline: 21 6 2024
pubmed: 21 6 2024
entrez: 20 6 2024
Statut: aheadofprint

Résumé

Topical corticosteroids are widely used as a treatment for itch and wheals (urticaria), but their benefits and harms are unclear. To systematically synthesize the benefits and harms of topical corticosteroids for the treatment of urticaria. We searched MEDLINE, EMBASE, and CENTRAL from database inception to March 23, 2024, for randomized trials addressing comparing topical corticosteroid to placebo for patients with urticaria (either chronic spontaneous or inducible urticaria or acute urticaria elicited from skin/intradermal allergy testing). Paired reviewers independently screened records, extracted data, and assessed risk of bias. Random-effects meta-analyses addressed urticaria severity, itch severity (numeric rating scale; range 0-10; higher is worse), and adverse events. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed certainty of evidence ratings. PROSPERO registration: CRD42023455182. Nineteen RCTs enrolled 379 participants with a median of mean age of 30.1 years (range 21.1 to 44.0). Compared to placebo, topical corticosteroids may reduce wheal size (ratio of means 0.47, 95%CI 0.38 to 0.59; low certainty) and itch severity (mean difference -1.30, 95%CI -5.07 to 2.46; very low certainty). Topical corticosteroids result in little to no difference in overall adverse events (94 fewer patients per 1000, 95%CrI 172 fewer to 12 more; high certainty). Compared to placebo, topical corticosteroids may result in a reduction of wheal size, and result in little to no difference in overall adverse events. Topical corticosteroids may reduce itch severity, but the evidence is very uncertain. Future large, randomized trials addressing the use of topical corticosteroids would further support optimal urticaria management.

Sections du résumé

BACKGROUND BACKGROUND
Topical corticosteroids are widely used as a treatment for itch and wheals (urticaria), but their benefits and harms are unclear.
OBJECTIVE OBJECTIVE
To systematically synthesize the benefits and harms of topical corticosteroids for the treatment of urticaria.
METHODS METHODS
We searched MEDLINE, EMBASE, and CENTRAL from database inception to March 23, 2024, for randomized trials addressing comparing topical corticosteroid to placebo for patients with urticaria (either chronic spontaneous or inducible urticaria or acute urticaria elicited from skin/intradermal allergy testing). Paired reviewers independently screened records, extracted data, and assessed risk of bias. Random-effects meta-analyses addressed urticaria severity, itch severity (numeric rating scale; range 0-10; higher is worse), and adverse events. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed certainty of evidence ratings. PROSPERO registration: CRD42023455182.
RESULTS RESULTS
Nineteen RCTs enrolled 379 participants with a median of mean age of 30.1 years (range 21.1 to 44.0). Compared to placebo, topical corticosteroids may reduce wheal size (ratio of means 0.47, 95%CI 0.38 to 0.59; low certainty) and itch severity (mean difference -1.30, 95%CI -5.07 to 2.46; very low certainty). Topical corticosteroids result in little to no difference in overall adverse events (94 fewer patients per 1000, 95%CrI 172 fewer to 12 more; high certainty).
CONCLUSION CONCLUSIONS
Compared to placebo, topical corticosteroids may result in a reduction of wheal size, and result in little to no difference in overall adverse events. Topical corticosteroids may reduce itch severity, but the evidence is very uncertain. Future large, randomized trials addressing the use of topical corticosteroids would further support optimal urticaria management.

Identifiants

DOI: 10.1016/j.anai.2024.06.003 PMID: 38901542
pubmed: 38901542
pii: S1081-1206(24)00348-X
doi: 10.1016/j.anai.2024.06.003
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Déclaration de conflit d'intérêts

Conflicts of Interest Apart from the following authors, the other authors declare no conflicts of interest. DML reports clinical research, consulting fees, and/or receiving payment or honoraria from AstraZeneca, Blueprint Medicines, Celldex Therapeutics, Genentech, Novartis, and Sanofi/Regeneron. MBS and ETO report consulting fees from Novartis and Sanofi/Regeneron. LAB reports consulting fees from Abbvie, Allakos, Arcutis Biotherapeutics, Arena Pharmaceuticals, Celldex Therapeutics, Dermavent, DermTech, Escient Pharma, Eli Lilly Company, Evelo Biosciences, Galderma, Incyte, Janssen, LEO Pharma, Merck, Nektar Therapeutics, Numab Therapeutics, Pfizer, Proteologix, Rapt Therapeutics, Regeneron, Ribon Therapeutics, Sanofi/Genzyme, Sanofi-Aventis, Sitryx Therapeutics, Stealth BioTherapeutics, Trevi Therapeutics, Union Therapeutics, Xencor and Yuhan, and serves as an investigator for Abbvie, AstraZeneca, DermTech, Kiniksa, Pfizer, Regeneron, Ribon Therapeutics, and Sanofi. JAB reports clinical research and consulting fees from AstraZeneca, Amgen, Allakos, Celldex Therapeutics, Escient Pharmaceuticals, Genentech, Novartis, and Sanofi/Regeneron.

Auteurs

Alexandro W L Chu (AWL)

Department of Medicine, McMaster University, Hamilton, ON, Canada; Evidence in Allergy Group, McMaster University, Hamilton, ON, Canada.

Daniel G Rayner (DG)

Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.

Xiajing Chu (X)

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

Lina Chen (L)

Department of Medicine, McMaster University, Hamilton, ON, Canada; Evidence in Allergy Group, McMaster University, Hamilton, ON, Canada.

Audrey Y H Dong (AYH)

Department of Medicine, McMaster University, Hamilton, ON, Canada; Evidence in Allergy Group, McMaster University, Hamilton, ON, Canada.

Susan Waserman (S)

Department of Medicine, McMaster University, Hamilton, ON, Canada.

Diane R Baker (DR)

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

Javed Sheikh (J)

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

Joseph Moellman (J)

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

David M Lang (DM)

Allergy and Clinical Immunology, Cleveland Clinic, Cleaveland, OH, USA.

Moshe Ben-Shoshan (M)

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

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.

Lisa A Beck (LA)

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

David A Khan (DA)

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

Eric T Oliver (ET)

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

Rachel N Asiniwasis (RN)

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

Jeffrey Chan (J)

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

Emily F Cole (EF)

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

Kathryn P Trayes (KP)

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

Winfred T Frazier (WT)

Department of Family Medicine, UPMC St. Margaret, Pittsburgh, PA, USA.

Lauren Runyon (L)

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

Kathryn E Wheeler (KE)

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

Sanaz Eftekhari (S)

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

Donna D Gardner (DD)

Allergy & Asthma Network, Vienna, VA, USA.

Tonya Winders (T)

Global Allergy & Airways Patient Platform, Vienna, Austria.

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.

Derek K Chu (DK)

Department of Medicine, McMaster University, Hamilton, ON, Canada; Evidence in Allergy Group, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada. Electronic address: chudk@mcmaster.ca.

Classifications MeSH