Comparative analysis of treatment protocols and clinical outcomes in the management of acute urticaria and angioedema in the emergency department

Objective: The purpose of the study was to identify clinical differences in patients with acute urticaria and/or angioedema receiving various treatment regimes in the emergency department of Lady Reading Hospital, Peshawar. Particularly, it compared modern antihistamine therapy with corticosteroids as an analogue to routine antihistamines with regard to the rate of symptom improvement, relapse, and hospitalisation. Methods: This was a cross-sectional descriptive study involving 542 patients with acute urticaria and/or angioedema. Patients were categorised into two groups: Group A, receiving a combination of antihistamines and corticosteroids (280); and Group B, receiving only antihistamines (262). Thus, the primary end points considered include time to resolution of symptoms, recurrence within 48 hours, and hospitalisation need. Data was analysed using the statistical package of social sciences (SPSS), while a p-value of < 0.05 formed the basis of significance. Results: The overall improvement time for symptoms was 3.6 hours in Group A and 5.1 hours in Group B (p < 0.001). The rates of recurrence were also lower in Group A (15%) than in Group B (29.8%, p < 0.01). Meanwhile, patients who were in Group A had 10% that needed inpatient admission as an intervention compared to 19.1% in Group B; p < 0.05. Side effects were few and were comparable between the two groups; therefore, patients in both groups had reactions such as drowsiness and gastrointestinal disturbances. Conclusion: Together, antihistamines plus corticosteroids were superior to antihistamines only in the treatment of acute urticarial and angioedema in patients in the emergency department. Patients reported symptoms resolved sooner, the rate of relapse was shorter, and hospitalisation was reduced. Based on this observation, corticosteroids should be considered as part of the usual care of patients presenting with moderate to severe symptoms in the emergency department. Future research should aim at sorting out various recommendations of treatment value for the purpose of achieving even better results of the therapy.