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Chronic urticaria. Taking prednisone. What are the side effects of the drug?

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Practicing since : 2006
Answered : 2015 Questions
I have chronic urticaria (hives) This has been going on for 1 and a half years. I have been on a daily dose of Benadryl
to help control hives. I have had limited success. Two days ago I started a dosage of prednisone. At the moment I am having a episode of hives. How long before the prednisone will help? WHAT SIDE EFFECTS SHOULD I BE CAREFUL ABOUT?
What has proven to be the best procedure to help chronic urticaria (hives). Have you ever seen a person with chronic urticaria (hives) cured? What specialty doctor or medical doctor should I see to have best chance of success to cure hives. At what point does chronic hives (urticaria) become a life threating situation. As I battle urticaria (hives) what is the best procedure to follow to improve my life style. It is not good! Can past history of either vitaligo or ricketts contribute to onset of hives? I have controlled all allergy symptoms-cleaned the house-changed beds-changed geographic locations( relocated for a while from New Mexico to Florida)-no gluten-no dairy products-and I still have chronic urticaria (hives)-Stayed away from pets-no alcohol-and ask-why do I continue to have hives?
Posted Tue, 5 Nov 2013 in Skin Hair and Nails
Answered by Dr. Kalpana Pathak 45 minutes later
Brief Answer:
Please read a detailed answer below

Detailed Answer:
Dear Sir,
Thanks for writing to us.
Chronic urticaria is defined as urticaria persisting on most of the days for six weeks or more. As you are facing this problem since an year, I would like to know if you suffer from hives almost on all days or get it occassionally.
Chronic urticaria is seen to be associated with thyroid disorders, autoimmune dieases. In most of the cases, there is no underlying cause.
So though you are taking every precaution possible, I would advise that do not be too cautious. For eg diet or pets can be cause of urticaria but even after controlling diet or avoiding pets, if you still get urticaria. These might not be inciting factor in your case. So do not stay away from your normal life style and urticaria should not be a deterrent to lead a normal life.

Past history of vitiligo or rickets has nothing to do with urticaria. However as you have asthma, urticaria and asthma can be linked as atopy. Atopic individuals are prone to have asthma, urticaira, eczema or running nose/ rhinitis.

Urticaria becomes a life threatening situation only if one gets respiratory distress or severe symptomatic features like acute pain in abdomen, vomiting etc. If ever you feel that your tongue is getting swollen or there is any difficulty in swallowing during an urticarial flare, please contact your health care provider immediately

You may XXXXXXX a dermatologist or allergic disaese specialist/ allergist to help you with urticaria

I have seen people having chronic urticaria. Firstly the patient needs to be counselled that medicines need to be taken to control urticaria and it may resolve on its own with time. Patient needs to be maintained on combination of antiallergics in a dose that prevents urticaria from occuring. Steroids are second line therapy and are added only when required. urticaria is quite common disorder and is seen frequently in skin OPDs

The best way to control is to take antiallergics.
As you have been taking benadryl and now on prednisolone but still having episodes. I would advise that you get the steroid tapered and then start with combination of antiallergics like levocetrizine 10 mg two times in a day along with hydroxyzine 25 mg two times in a day/ if this helps you, continue with same atleast for month and then the doctor should start tapering the morning and evening dose according to response or flare of urticaria. Sometimes for better response we add rantidine 150 mg two times in a day along with the above prescription.

Hope this answered your query.
Take care
Above answer was peer-reviewed by
Follow-up: Chronic urticaria. Taking prednisone. What are the side effects of the drug? 19 minutes later
Thank you Dr. Pathak. I have seen 3 allergy doctors, two dermatologist, three primary doctors, and a rheumatologist doctor. I have tried the above mentioned procedures(the ones mentioned in your answer) No help. Still ongoing. You say time can resolve the condition. Not in this case. I tried Rantidine along with levocetrizine and hydroxyzine. Not much help. I am now in the next step-steroid
prednisone). I am in Albuquerque, New Mexico and seeing three doctors now. Primary-allergy, and a dermatologist. What you have outlined above is close to what I have been doing for a year now. I am not giving up-this is why I contacted your for more help. I am not sure what a phone or a text format like this can help.
But I had bad hives last night and got to keep looking for help. Can you make any more suggestions or keep in touch as I progress forward?
I need to add. I get hives almost every day. But, I have a severe case of hives about 2-3 days a week. I have had blood lab work done for thyroid and parasite issues. The readings are ok. Though about 20 years ago I did have a hyperactive thyroid that was controlled with medicine. Also I did have a reduced Kidney function report about a year ago. That has been tested and seems to be ok.
My dosage of prednisone (deltasone) is 10 mg tablet-4 daily. Today is my third day on this new pill. I will continue the Benadryl and the cetirizine. My one doctor(rheumatology) had a test done and suggested that my lgG4 and IgE
serum levels are suspect. He has suggested that I may have to try Omalizumab
which is a humanized monoclonal antibody that binds to circulating igE and reduces the release of mediators from mast cells and basophils. Are you or a colleague familiar with this treatment? I need help!
Are you going to stay in touch with me?
Answered by Dr. Kalpana Pathak 21 hours later
Brief Answer:
Yes I will remain in touch with you sir!

Detailed Answer:
Thanks for writing back.
Firstly accept my apology for the delayed response.
Urticaria at times can be refractory to treatment.

Ideally we start treatment with antihistamines in normal standard dosing. If response is not achieved , then we can safely increase the dose of antihistamine upto four times the normal dosing. if still no response is seen, then steroids are started. you have been prescribed steroid in high dose of 40 mg per day. If this too does not give result then anti IgE monoclonal antibody drugs Iike omalizumab is tried. Omalizumab is given monthly as injection. It basically stabilises mast cells and works through IgE. In simpler words it reduces sensitivity to allergens. I have personally never used it and also its a costly drug.
Right now I would just advise that you continue steroids along with cetrizine and hydroxyzine to see how much response you get.

Hope this helped.
Be assured I will be available for further follow up. Whenever required, you can activate this thread.

Above answer was peer-reviewed by
Follow-up: Chronic urticaria. Taking prednisone. What are the side effects of the drug? 4 hours later
Dr. Pathak. Thank you for your 2nd answer. I will currently stay with the steroid Prednisone for my Hives issue. This appears to be a health issue that the medical community does not have a complete handle on. I have a severe case. I am always looking for help. (I can't give up hope) My life style is not very good at the
moment. I even retired early from teaching to concentrate on getting better.
If you talk with a colleague or another Dr. who has expertise in this field please get back to me one more time with any ideas.
Answered by Dr. Kalpana Pathak 2 days later
Brief Answer:
Right now continue with steroids and antihistamine

Detailed Answer:
Firstly accept my apologies for delayed response.
Right now you need to continue with oral steroids and antihistamines. Most probably it should control your urticaria. If not much response is seen, as advised by your doctor you may start with omalizumab. Other drugs that can be tried are methotrexate and cyclosporine.
Personally I feel combination of antihistamines in high dose and tapering doses of steroid should give you desirable response.
wish you speedy recovery.
You may get back to me for further queries, if the need be.
Above answer was peer-reviewed by
Follow-up: Chronic urticaria. Taking prednisone. What are the side effects of the drug? 57 minutes later
Dr. Pathak Thanks for your follow-up answer. My hives have dissipated since I started the 40 mg of prednisone per day along with Benadryl at night. Not completely gone-but a bit manageable. My local MD has recommended the Benadryl and to also taper the steroids as you have suggested. The omalizumab will not come into play unless I can't control the situation. It may take several opinions and some follow up to get me on a healthy track. Please keep me in mine! This last year has been hard.
Answered by Dr. Kalpana Pathak 28 hours later
Brief Answer:
Steroid and antihistamines would work.

Detailed Answer:
Thanks for writing back.
I believe steroid and antihistamine together would definitely help you out.
You are taking steroids in tapering dose. Its good as steroids should be tapered to prevent any untoward side effects. Along with steroid, you are taking Benadryl only. Benadryl is sedating antihistamine and is quite useful in urticaria. Personally I feel you will achieve better control, if you take a non sedating antihistamine like levocetirizine two times in a day and Benadryl in night.

Wish you speedy recovery.
Take care
Above answer was peer-reviewed by
Follow-up: Chronic urticaria. Taking prednisone. What are the side effects of the drug? 4 hours later
Hi Dr. Pathak. Yes I will try either levocetirizine or cetirizine along with the steroid. I am on 40 ml a day of prednisone. It has helped-but not completely and only time will tell. LAST NIGHT I HAD SOME HIVE REACTION ON MY CHIN AND IN BETWEEN MY FINGERS. When the Benadryl kicked in I did clear and sleep. But-can you imagine before the steroid I was getting thousands of hives across my body-(legs-back-side-butt-chest-face-neck hands-feet-anywhere there is skin) each night! My life style was not good. My hope is with the advice of you doctors and the proper medicine to control these hives I can improve my life style. Realistically I don't think I will completely eliminate my condition in my life time.
My own genetics are not going to fully cooperate in this issue. Please-monitor and keep in touch. You seem to have some expertise in this area. Thank you.
Answered by Dr. Kalpana Pathak 29 hours later
Brief Answer:
Steroid and antihistamines would help.

Detailed Answer:
Dear sir,
Please continue with steroid in tapering dose. Once a low dose of steroid is reached, it should be maintained for few days. Take cetirizine and Benadryl both for better response.
You can always activate this thread for further follow up with me.
Wishing you good health.
Above answer was peer-reviewed by
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