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Chu AWL, Rayner DG, Chu X, Chen L, Dong AYH, Waserman S, Baker DR, Sheikh J, Moellman J, Lang DM, Ben-Shoshan M, Mathur SK, Beck LA, Khan DA, Oliver ET, Asiniwasis RN, Chan J, Cole EF, Trayes KP, Frazier WT, Runyon L, Wheeler KE, Eftekhari S, Gardner DD, Winders T, Bernstein JA, Saini SS, Chu DK. Topical corticosteroids for hives and itch (urticaria): Systematic review and Bayesian meta-analysis of randomized trials. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00348-X. [PMID: 38901542 DOI: 10.1016/j.anai.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Topical corticosteroids are widely used as a treatment for itch and wheals (urticaria), but their benefits and harms are unclear. OBJECTIVE To systematically synthesize the benefits and harms of topical corticosteroids for the treatment of urticaria. METHODS We searched MEDLINE, EMBASE, and CENTRAL from database inception to March 23, 2024, for randomized trials comparing topical corticosteroids with 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 A total of 19 randomized controlled trials enrolled 379 participants with a median of mean age of 30.1 (range 21.1-44.0) years. Compared with placebo, topical corticosteroids may reduce wheal size (ratio of means 0.47, 95% CI 0.38-0.59; 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% credible intervals 172 fewer to 12 more; high certainty). CONCLUSION Compared with placebo, topical corticosteroids may result in a reduction of wheal size and 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.
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Affiliation(s)
- Alexandro W L Chu
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada
| | - Daniel G Rayner
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Xiajing Chu
- Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lina Chen
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada
| | - Audrey Y H Dong
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada
| | - Susan Waserman
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Diane R Baker
- Department of Dermatology, Oregon Health & Sciences University, Portland, Oregon
| | - Javed Sheikh
- Department of Clinical Immunology and Allergy, Southern California Permanente Medical Group, Los Angeles, California
| | - Joseph Moellman
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David M Lang
- Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio
| | - Moshe Ben-Shoshan
- Division of Allergy, Immunology and Dermatology, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Sameer K Mathur
- Division of Allergy, Pulmonary and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Lisa A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Eric T Oliver
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel N Asiniwasis
- Division of Dermatology, Department of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Jeffrey Chan
- Emergency Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Emily F Cole
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Kathryn P Trayes
- Department of Family and Community Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Winfred T Frazier
- Department of Family Medicine, UPMC St. Margaret, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Lauren Runyon
- Division of Allergy and Immunology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kathryn E Wheeler
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Sanaz Eftekhari
- Asthma and Allergy Foundation of America, Arlington, Virginia
| | | | - Tonya Winders
- Global Allergy & Airways Patient Platform, Vienna, Austria
| | - Jonathan A Bernstein
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sarbjit S Saini
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Derek K Chu
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada; The Research Institue of St. Joe's Hamilton, Hamilton, Ontario, Canada.
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Ugwu N, Cheraghlou S, Antaya RJ, Feng H, Cohen JM. Trends in office visits and treatment for urticaria in children in the United States, 1998-2016. Pediatr Dermatol 2021; 38:1162-1168. [PMID: 34339077 DOI: 10.1111/pde.14726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES Urticaria is a common condition with an estimated prevalence of up to 23% in the pediatric population. Studies characterizing visits and treatments for urticaria in the pediatric population are unavailable. Understanding visit and treatment trends for urticaria in the pediatric population may help inform care for patients with urticaria. METHODS A total of 108 278 outpatient records from the National Ambulatory Medical Care Survey representing 3.4 billion visits by patients of age 18 and younger were analyzed. This study included the calendar years 1998 through 2016. RESULTS Pediatricians saw the largest proportion of all visits (52.7%). Male and female patients accounted for approximately equal proportions of all visits for urticaria. There was a slight male predominance in visits to pediatricians (53.7%), whereas dermatologists saw female patients more frequently (63.3%). Most visits for urticaria were by non-Hispanic (78.1%) and White (78.2%) patients. H1 antihistamines were the most commonly prescribed treatment (70.3%), whereas topical corticosteroids were prescribed least frequently (4.9%). Topical corticosteroids were most frequently prescribed by dermatologists (7.7%). Non-H1 antihistamine and non-corticosteroid therapy were prescribed in 9.7% of all visits and in 4.5% of visits to pediatricians. Most visits for urticaria were to physicians in metropolitan areas (88.8%). Pediatricians saw the highest number of non-metropolitan area visits (56.3%). CONCLUSIONS H1 antihistamines were the most commonly used therapy (70%), consistent with established treatment guidelines. Male and female pediatric patients present equally often for urticaria, but sex differences were seen with visit frequencies to certain specialties.
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Affiliation(s)
- Nelson Ugwu
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Shayan Cheraghlou
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Richard J Antaya
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.,Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT, USA
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
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