Background: The effectiveness of corticosteroids in antihistamine-resistant chronic urticaria (CU) is widely accepted although large studies on their use in this disease are lacking.

Objective: To assess the proportion of patients with antihistamine-resistant CU that respond to a course of corticosteroids.

Methods: We studied 750 adult patients with CU and prescribed a course of oral corticosteroids (starting with prednisone 25 mg/day for 3 days) to those who reported little or partial response to antihistamine treatment. The corticosteroid treatment was considered effective if it resulted in long-term control of the disease with antihistamines only. Patients showing a temporary response were offered a second course of prednisone, at the end of which temporary responders and nonresponders were offered ciclosporin therapy for 3 months.

Results: A total of 660 patients (88%) (male/female, 194/556) responded to antihistamine treatment. In 40/86 patients (47%), prednisone induced remission of the disease and subsequent control with antihistamines at licensed doses only. Thirty-five patients responded well but relapsed when prednisone doses were tapered or shortly after withdrawal. In all responders, the effect was appreciable as early as the day after the first 25 mg dose. In 8/23 temporary responders, a second course of prednisone induced remission of the disease; the other 15 patients responded well but only temporarily.

Conclusions: A single short course of prednisone induced remission in nearly 50% of patients with CU, and a second course induced remission in a further 9%. Less than 15% of patients did not respond at all to this treatment.

Key words: Chronic urticaria. Corticosteroids. Antihistamines. Therapy.