- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03296358
Adding a Short Burst of Corticosteroid to the Conventional Treatment of H1 Antihistamines in Emergency Department.
A Randomized, Double-blinded, Controlled Trial of Adding a Short Burst of Corticosteroid to the Conventional Treatment of H1 Antihistamines
Study Overview
Status
Intervention / Treatment
Detailed Description
Research Methodology
Target Population Patients visit emergency room at King chulalongkorn memorial hospital (KCMH) age between 18-50 years who meet the following criteria of acute urticarial such as
- eruption of wheals, central swelling of various sizes, with or without surrounding erythema; with or without angioedema
- pruritus or occasional burning sensation
- skin returning to normal appearance, usually within 1-24 hours
Exclusion criteria
- patients who have urticarial for more than 48 hours
- have severe underlying disease such as heart disease, kidney disease, liver disease
- pregnancy
- history of Chlorpheniramine, steroid, antihistamines allergy
- history of antihistamine or steroid uses within 48 hours before emergency department visit
- diabetes mellitus
- suspected of more severe disease or severe allergic reaction
- patients who don't have pruritus
- patients who have history of chronic urticaria
Informed consent process The doctor who is the principal investigator or his assigned colleagues describe the research's details and methods to an enrolled patients. The documents which contain the details of the research project are also given. Inform consents then were signed before the beginning of the experiment.
The volunteer would be in a research process during their first 1-2 hours in emergency department, with the follow up time at 1 week and 1 month
After the investigator complete the inclusion and exclusion criteria, the participants would be random into 3 groups. The randomization process would already be prepared into 3 groups with a number coding by the statistician who doesn't get involve in the rest of experiment. The drugs would be in the 3 group of sealed envelopes which have 3 kinds of drug combination :
- Control group : Chlorpheniramine 10 mg/amp ; 1 ampule and cetirizine 10 mg 7 tabs
- Experiment group : Chlorpheniramine 10 mg/amp ; 1 ampule, Dexamethasone 5 mg/amp; 1 ampule and cetirizine 10 mg 7 tabs
- Experiment group : Chlorpheniramine 10 mg/amp ; 1 ampule, Dexamethasone 5 mg/amp; 1 ampule, cetirizine 10 mg 7 tabs, and prednisolone 5 mg 20 tabs After the envelopes are sealed, it will be code in an order of number. All of the enrolled patients will get Chlorpheniramine 10 mg intravenous. The patients who are assigned in experiment group will get an additional Dexamethasone 5 mg intravenous. The preparation of both drugs will be result to be a 10 ml of clear fluid. The control group will get a 10 ml of sterile fluid in 10 ml syringe as a placebo. The drugs will be prepared and delivered be the nurse who knows about the research process but does not get involved in other process of the research.
After the experiment period in emergency department, all of the enrolled patients will get cetirizine 10 mg 7 tabs as a home medication. One experiment group will get prednisolone 5 mg 20 tabs. They will be appointed to an outpatient department in 1 week and 1 month for the follow up of an acute urticarial rash.
Sample size calculation Investigators do the hypothesis that the experiment groups who get both Chlorpheniramine 10 mg and Dexamethasone 5 mg intravenous would have the itch score decrease at least 2 points so this experiment wants minimal clinical difference at "2". This number got from our expert in immunology and skin disease. The standard deviation for this experiment is 2.1 from the previous research. Calculated by G*Power version 3.1 (Dusseldorf, Germany) for an independent t-test , two-tailed analysis, alpha error probability = 0.05 and power of analysis (1-beta error probability) = 0.90 The sample size for each group is 23 persons so the patients enroll in this research would be 69 persons.
Data Collection
- Sex and age
- Time since the first rash erupt before coming to emergency department (hrs)
- %body surface area of rash involved
- Urticarial activity score (UAS) before and after treatment
- Itch score (Visual analog scale (VAS) score) by letting the patients mark a cross on a straight line. The end of the left side of a line represents "0 = no pain at all", and the end of the right side of a line represents "10 = the worst pain ever possible". The patients aren't allowed to compare the previous VAS score before doing the cross.
- Side effect of drugs
- Other medicine used as indicated
- Patients' satisfaction score
- The recurrence of rash 1 week after the rash onset
- The recurrence of rash 1 month after the rash onset which will be evaluate by an expert in immunology and skin disease.
Data Analysis and Statistics
Descriptive statistics : Chi-square Student t-test and paired t-test for data analysis of continuous variables (such as itch score (VAS) and pair wise comparison for cumulative increase in the proportion of the "responder" over the time
Statistical significant when p-value < 0.05
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Bangkok
-
Pathum Wan, Bangkok, Thailand, 10600
- Chulalongkorn Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
Patients visit emergency room at King chulalongkorn memorial hospital (KCMH) age between 18-50 years who meet the following criteria of acute urticarial such as
- eruption of wheals, central swelling of various sizes, with or without surrounding erythema; with or without angioedema
- pruritus or occasional burning sensation
- skin returning to normal appearance, usually within 1-24 hours
Exclusion Criteria:
- patients who have urticarial for more than 48 hours
- have severe underlying disease such as heart disease, kidney disease, liver disease
- pregnancy
- history of chlorpheniramine maleate, steroid, antihistamines allergy
- history of antihistamine or steroid uses within 48 hours before ED visit
- diabetes mellitus
- suspected of more severe disease or severe allergic reaction
- patients who don't have pruritus
- patients who have history of chronic urticaria
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Control group
Chlorpheniramine 10 mg/amp ; 1 ampule Cetirizine 10 mg 7 tabs once daily (OD) as home medication
|
|
Experimental: Experiment 1
Chlorpheniramine 10 mg/amp ; 1 ampule, IV Dexamethasone 5 mg/amp; 1 ampule Cetirizine 10 mg 7 tabs 1 tab OD as home medication
|
The patients would be random into 3 groups.
The randomization process would already be prepared into 3 groups with a number coding by the statistician who doesn't get involve in the rest of experiment.
The drugs would be in the 3 group of sealed envelopes which have 3 kinds of drug combination After the envelopes are sealed, it will be code in an order of number.
Experiment 1 and Experiment 2 groups would receive IV Dexamethasone in emergency department (ED).
Other Names:
|
Experimental: Experiment 2
Chlorpheniramine 10 mg/amp ; 1 ampule, IV Dexamethasone 5 mg/amp; 1 ampule Cetirizine 10 mg 7 tabs 1 tab OD as home medication Oral prednisolone 5 mg 20 tabs ; 2*2 po pc as home medication
|
The patients would be random into 3 groups.
The randomization process would already be prepared into 3 groups with a number coding by the statistician who doesn't get involve in the rest of experiment.
The drugs would be in the 3 group of sealed envelopes which have 3 kinds of drug combination After the envelopes are sealed, it will be code in an order of number.
Experiment 1 and Experiment 2 groups would receive IV Dexamethasone in emergency department (ED).
Other Names:
The patients would be random into 3 groups.
The randomization process would already be prepared into 3 groups with a number coding by the statistician who doesn't get involve in the rest of experiment.
The drugs would be in the 3 group of sealed envelopes which have 3 kinds of drug combination After the envelopes are sealed, it will be code in an order of number.
Experiment 2 groups would receive IV Dexamethasone in ED and Oral prednisolone as home medication.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Itch score
Time Frame: 60 mins
|
letting the patients mark a cross on a straight line.
The end of the left side of a line represents "0 = no itch at all", and the end of the right side of a line represents "10 = the worst itch ever possible".
The patients aren't allowed to compare the previous VAS score before doing the cross.
|
60 mins
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Chronic urticaria incidence
Time Frame: 1 week, 1 month
|
Chronic urticaria incidence after the use of steroid compare with no steroid use in treatment.
|
1 week, 1 month
|
Itch score
Time Frame: 0, 15, 30 mins
|
letting the patients mark a cross on a straight line.
The end of the left side of a line represents "0 = no itch at all", and the end of the right side of a line represents "10 = the worst itch ever possible".
The patients aren't allowed to compare the previous VAS score before doing the cross.
|
0, 15, 30 mins
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Pakhawadee Palungwachira, M.D., King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Skin Diseases
- Immune System Diseases
- Hypersensitivity, Immediate
- Skin Diseases, Vascular
- Hypersensitivity
- Urticaria
- Physiological Effects of Drugs
- Autonomic Agents
- Peripheral Nervous System Agents
- Anti-Inflammatory Agents
- Antineoplastic Agents
- Antiemetics
- Gastrointestinal Agents
- Glucocorticoids
- Hormones
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Antineoplastic Agents, Hormonal
- Dexamethasone
- Prednisolone
Other Study ID Numbers
- 668/2017
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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