Abstract：
BACKGROUND: Short courses of adjunctive systemic corticosteroids are commonly used to treat acute urticaria and chronic urticaria flares (both with and without mast cell-mediated angioedema), but their benefits and harms are unclear.
OBJECTIVE: To evaluate the efficacy and safety of treating acute urticaria or chronic urticaria flares with versus without systemic corticosteroids.
METHODS: We searched the MEDLINE, EMBASE, CENTRAL, CNKI, VIP, Wanfang, and CBM databases from inception to July 8, 2023, for randomized controlled trials of treating urticaria with versus without systemic corticosteroids. Paired reviewers independently screened records, extracted data, and appraised risk of bias with the Cochrane 2.0 tool. We performed random-effects meta-analyses of urticaria activity, itch severity, and adverse events. We assessed certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) approach.
RESULTS: We identified 12 randomized trials enrolling 944 patients. For patients with low or moderate probability (17.5%-64%) to improve with antihistamines alone, add-on systemic corticosteroids likely improve urticaria activity by a 14% to 15% absolute difference (odds ratio [OR], 2.17, 95% confidence interval [CI]: 1.43-3.31; number needed to treat [NNT], 7; moderate certainty). Among patients with a high chance (95.8%) for urticaria to improve with antihistamines alone, add-on systemic corticosteroids likely improved urticaria activity by a 2.2% absolute difference (NNT, 45; moderate certainty). Corticosteroids may improve itch severity (OR, 2.44; 95% CI: 0.87-6.83; risk difference, 9%; NNT, 11; low certainty). Systemic corticosteroids also likely increase adverse events (OR, 2.76; 95% CI: 1.00-7.62; risk difference, 15%; number needed to harm, 9; moderate certainty).
CONCLUSIONS: Systemic corticosteroids for acute urticaria or chronic urticaria exacerbations likely improve urticaria, depending on antihistamine responsiveness, but also likely increase adverse effects in approximately 15% more.
OBJECTIVE: To evaluate the efficacy and safety of treating acute urticaria or chronic urticaria flares with versus without systemic corticosteroids.
METHODS: We searched the MEDLINE, EMBASE, CENTRAL, CNKI, VIP, Wanfang, and CBM databases from inception to July 8, 2023, for randomized controlled trials of treating urticaria with versus without systemic corticosteroids. Paired reviewers independently screened records, extracted data, and appraised risk of bias with the Cochrane 2.0 tool. We performed random-effects meta-analyses of urticaria activity, itch severity, and adverse events. We assessed certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) approach.
RESULTS: We identified 12 randomized trials enrolling 944 patients. For patients with low or moderate probability (17.5%-64%) to improve with antihistamines alone, add-on systemic corticosteroids likely improve urticaria activity by a 14% to 15% absolute difference (odds ratio [OR], 2.17, 95% confidence interval [CI]: 1.43-3.31; number needed to treat [NNT], 7; moderate certainty). Among patients with a high chance (95.8%) for urticaria to improve with antihistamines alone, add-on systemic corticosteroids likely improved urticaria activity by a 2.2% absolute difference (NNT, 45; moderate certainty). Corticosteroids may improve itch severity (OR, 2.44; 95% CI: 0.87-6.83; risk difference, 9%; NNT, 11; low certainty). Systemic corticosteroids also likely increase adverse events (OR, 2.76; 95% CI: 1.00-7.62; risk difference, 15%; number needed to harm, 9; moderate certainty).
CONCLUSIONS: Systemic corticosteroids for acute urticaria or chronic urticaria exacerbations likely improve urticaria, depending on antihistamine responsiveness, but also likely increase adverse effects in approximately 15% more.
摘要：
背景：短期辅助全身性皮质类固醇通常用于治疗急性荨麻疹和慢性荨麻疹（伴有或不伴有肥大细胞介导的血管性水肿），但它们的好处和危害尚不清楚。
目的：评价全身使用糖皮质激素与不使用糖皮质激素治疗急性荨麻疹或慢性荨麻疹的疗效和安全性。
方法：我们搜索了MEDLINE，EMBASE,中部,CNKI,VIP,万方,和从开始到2023年7月8日的CBM数据库，用于使用和不使用全身性皮质类固醇治疗荨麻疹的随机对照试验。配对的审稿人独立筛选记录，提取的数据，并使用Cochrane2.0工具评估偏差风险。我们做了荨麻疹活动的随机效应荟萃分析，瘙痒严重程度和不良事件。我们使用分级方法评估了证据的确定性。
结果：我们确定了12项随机试验，纳入944例患者。对于仅使用抗组胺药改善的概率低或中等（17.5％至64％）的患者，附加的全身性皮质类固醇可能使荨麻疹活动改善14%~15%的绝对差异(比值比[OR]2.17,95CI1.43~3.31;治疗所需数量[NNT]7;中度确定性).在仅使用抗组胺药的荨麻疹改善的机会很高（95.8％）的患者中，附加的全身性皮质类固醇可能将荨麻疹活性改善了2.2%的绝对差异(NNT，45；中等确定性)。皮质类固醇可以改善瘙痒严重程度（或，2.44；95CI0.87-6.83；风险差异，9%；NNT，11；低确定性)。全身性皮质类固醇也可能增加不良事件（OR，2.76；95CI1.00-7.62；风险差异，15%；伤害[NNH]所需的数量，9；中等确定性)。
结论：全身性皮质类固醇治疗急性荨麻疹或慢性荨麻疹加重可能改善荨麻疹，根据抗组胺反应，但也可能增加约15%以上的不良反应。
目的：评价全身使用糖皮质激素与不使用糖皮质激素治疗急性荨麻疹或慢性荨麻疹的疗效和安全性。
方法：我们搜索了MEDLINE，EMBASE,中部,CNKI,VIP,万方,和从开始到2023年7月8日的CBM数据库，用于使用和不使用全身性皮质类固醇治疗荨麻疹的随机对照试验。配对的审稿人独立筛选记录，提取的数据，并使用Cochrane2.0工具评估偏差风险。我们做了荨麻疹活动的随机效应荟萃分析，瘙痒严重程度和不良事件。我们使用分级方法评估了证据的确定性。
结果：我们确定了12项随机试验，纳入944例患者。对于仅使用抗组胺药改善的概率低或中等（17.5％至64％）的患者，附加的全身性皮质类固醇可能使荨麻疹活动改善14%~15%的绝对差异(比值比[OR]2.17,95CI1.43~3.31;治疗所需数量[NNT]7;中度确定性).在仅使用抗组胺药的荨麻疹改善的机会很高（95.8％）的患者中，附加的全身性皮质类固醇可能将荨麻疹活性改善了2.2%的绝对差异(NNT，45；中等确定性)。皮质类固醇可以改善瘙痒严重程度（或，2.44；95CI0.87-6.83；风险差异，9%；NNT，11；低确定性)。全身性皮质类固醇也可能增加不良事件（OR，2.76；95CI1.00-7.62；风险差异，15%；伤害[NNH]所需的数量，9；中等确定性)。
结论：全身性皮质类固醇治疗急性荨麻疹或慢性荨麻疹加重可能改善荨麻疹，根据抗组胺反应，但也可能增加约15%以上的不良反应。
