Treatment - Corticosteroids

Corticosteroids, or steroids as they are more commonly known, are drugs used to reduce inflammation and immune system activity. This is a large group of medicines used for short-term control of severe symptoms of chronic hives.

How do steroids work?

Steroids are a type of hormone. Your body naturally makes a form of steroids in your adrenal glands. Steroids can also be made by a drug company. These drugs are different from the type of steroids used to enhance physical performance.1

Lab-made steroids are designed to work like cortisol, a corticosteroid the body makes naturally. Steroids help control inflammation, immune system activity, and other body processes.1

These drugs work by lowering the levels of body chemicals that cause inflammation. They also decrease immune system activity by changing how white blood cells work. Steroids are used to treat many conditions besides chronic hives, including:1

  • Asthma
  • Chronic obstructive pulmonary disease (COPD)
  • Rheumatological conditions (inflammatory or immune diseases of the joints, muscles, or other organs)
  • Atopic dermatitis (eczema)
  • Hives and angioedema (swelling)

For chronic hives, steroids may be used as a skin cream or as a pill. Oral corticosteroids may help control symptoms during a severe episode. In most cases, they are only used if H1 antihistamines and other drugs are not controlling symptoms.2-4

Doctors try to avoid long-term treatment with steroids due to the risk of side effects. Experts recommend that oral corticosteroids are used for less than 10 days. More research is needed to find the best dose and length of treatment in people with chronic hives.2,5

Examples of steroids

Glucocorticoids are the type of steroid used to treat chronic hives. They work by attaching to a protein in your cells called the glucocorticoid receptor. This changes the levels of other proteins involved in inflammation.1

Examples of glucocorticoids include:1

  • Prednisone
  • Cortisone
  • Methylprednisolone
  • Prednisolone

Prednisone is the most common type of corticosteroid used to treat chronic hives.2

What are the possible side effects of steroids?

Your risk of side effects depends on the dose and length of treatment. A higher dose and longer treatment course increases the risk of side effects. This is why your doctor will use the lowest dose possible for the shortest time possible.1

Common side effects of oral corticosteroids include:1

  • Increased appetite and weight gain
  • Mood changes and problems with memory and confusion
  • Blurry vision
  • Higher risk of infection
  • Swollen face
  • Acne
  • High blood pressure and blood sugar
  • Eye problems, such as cataracts
  • Frequent urination
  • Thinning bones (osteoporosis)

These are not all the possible side effects of steroids. Talk to your doctor about what to expect when taking steroids. You also should call your doctor if you have any changes that concern you when taking these drugs.

Things to know about steroids

Take corticosteroids exactly as your doctor prescribes. They will usually suggest taking prednisone with food every day for a few days. Your doctor will then reduce your dose as symptoms are controlled.2

Your doctor can help you weigh the risks and benefits of corticosteroids. The best way to reduce side effects is to reduce your need for corticosteroids. Most people with chronic hives can control symptoms with H1 antihistamines, which have few side effects. However, sometimes steroids may still be needed.

Ways to reduce side effects of steroids include:6

  • Ask your doctor about trying lower doses or taking them every other day instead of daily
  • Ask your doctor if topical (skin cream) versions can be used instead of oral corticosteroids
  • Ask your doctor if calcium or vitamin D supplements can help protect you from bone thinning
  • See your doctor regularly to be monitored for side effects

Steroids can worsen certain other conditions, such as diabetes. Before beginning treatment for chronic hives, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.1

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Written by: Matt Zajac | Last reviewed: April 2022