Chronic urticaria in pregnancy or lactation: what to do when H1-antihistamine updosing has not achieved complete control
Clinical scenario
Female patients with chronic urticaria who are pregnant or breastfeeding require special consideration. The standard treatment algorithm is applied with caution in this population, following careful risk–benefit assessment. Drugs that are contraindicated or not suitable in pregnancy are excluded from consideration.
Previous step — target not reached
The prior step for this population involved carefully suggested updosing of a modern 2nd-generation H1-antihistamine. Where this has not achieved the treatment target — complete symptom control (continuous UAS = 0, UCT = 16) — the protocol defines the next clinical step.
Next-line approach
When H1-antihistamine updosing is insufficient in this setting, the next step involves an add-on biologic therapy that has been reported to be safe in pregnancy. The full regimen — including sequencing and all safety considerations — is in the structured protocol.
Treatment goal: continuous complete symptom control (UAS = 0, UCT = 16) and normalisation of quality of life.
References
DOI: 10.1111/all.70210
- We suggest using the same treatment algorithm with caution both in pregnant and lactating women after risk-benefit assessment.
- Drugs contraindicated or not suitable in pregnancy should not be used.
- The use of omalizumab in pregnancy has been reported to be safe and to date there is no indication of teratogenicity.
- The goal of treatment is to treat the disease until it is gone, as efficiently and as safely as possible, aiming at a continuous complete control (consistently UAS = 0/UCT = 16) and a normalization of quality of life.