Age-Dependent Increase in Oral Steroid Utilization in the Treatment of Chronic Urticaria

Abstract

RationaleChronic urticaria (CU) varies in disease frequency and severity. Systemic steroids are often utilized when antihistamine therapy fails to provide adequate symptom relief. We sought to identify distinguishing features of subjects with CU who required oral steroid therapy for control.MethodsWe report a retrospective chart review of 206 subjects with CU who had demographic, clinical, and treatment data recorded under an IRB-approved protocol.ResultsWe identified 57 subjects with CU who were prescribed oral steroids and 149 subjects with CU who did not require oral steroids. As expected, CU subjects requiring oral steroids had a more severe course as assessed by requiring higher doses of non-sedating antihistamines (p=0.02) and sedating antihistamines (p<0.001), more emergency room visits for CU (p<0.001), and had more frequent concomitant angioedema (p=0.04). After dividing the cohort into four quartiles, we found a trend towards older subjects requiring steroid therapy for CU control, from 17% requiring steroids (age<28 yo) to 33% requiring steroids (age>54 yo), p=0.05 by Chi-squared analysis. All other variables were not statistically significant among these two groups.ConclusionsA trend towards older CU subjects requiring steroid therapy for treatment of a more severe course was identified. Increased age as a risk factor for CU disease severity has not been conclusively identified in the past. RationaleChronic urticaria (CU) varies in disease frequency and severity. Systemic steroids are often utilized when antihistamine therapy fails to provide adequate symptom relief. We sought to identify distinguishing features of subjects with CU who required oral steroid therapy for control. Chronic urticaria (CU) varies in disease frequency and severity. Systemic steroids are often utilized when antihistamine therapy fails to provide adequate symptom relief. We sought to identify distinguishing features of subjects with CU who required oral steroid therapy for control. MethodsWe report a retrospective chart review of 206 subjects with CU who had demographic, clinical, and treatment data recorded under an IRB-approved protocol. We report a retrospective chart review of 206 subjects with CU who had demographic, clinical, and treatment data recorded under an IRB-approved protocol. ResultsWe identified 57 subjects with CU who were prescribed oral steroids and 149 subjects with CU who did not require oral steroids. As expected, CU subjects requiring oral steroids had a more severe course as assessed by requiring higher doses of non-sedating antihistamines (p=0.02) and sedating antihistamines (p<0.001), more emergency room visits for CU (p<0.001), and had more frequent concomitant angioedema (p=0.04). After dividing the cohort into four quartiles, we found a trend towards older subjects requiring steroid therapy for CU control, from 17% requiring steroids (age<28 yo) to 33% requiring steroids (age>54 yo), p=0.05 by Chi-squared analysis. All other variables were not statistically significant among these two groups. We identified 57 subjects with CU who were prescribed oral steroids and 149 subjects with CU who did not require oral steroids. As expected, CU subjects requiring oral steroids had a more severe course as assessed by requiring higher doses of non-sedating antihistamines (p=0.02) and sedating antihistamines (p<0.001), more emergency room visits for CU (p<0.001), and had more frequent concomitant angioedema (p=0.04). After dividing the cohort into four quartiles, we found a trend towards older subjects requiring steroid therapy for CU control, from 17% requiring steroids (age<28 yo) to 33% requiring steroids (age>54 yo), p=0.05 by Chi-squared analysis. All other variables were not statistically significant among these two groups. ConclusionsA trend towards older CU subjects requiring steroid therapy for treatment of a more severe course was identified. Increased age as a risk factor for CU disease severity has not been conclusively identified in the past. A trend towards older CU subjects requiring steroid therapy for treatment of a more severe course was identified. Increased age as a risk factor for CU disease severity has not been conclusively identified in the past.