This protocol applies to patients with cold urticaria who are pregnant or breastfeeding — a setting where the selection of any pharmacological treatment requires particular caution and individual risk–benefit assessment.
The same treatment algorithm used in the general population is applied here, but with caution. Drugs that are contraindicated or not suitable in pregnancy must not be used. Systemic treatment carries additional risk, especially during the first trimester.
Avoidance of cold exposure is central. Where pharmacological treatment is indicated, a specific modern antihistamine class is preferred — with careful selection guided by trimester and breastfeeding status. The full protocol specifies which agents are preferred, which may be considered, and which must be avoided.
DOI: 10.1111/all.15090
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.
In CIndU, avoidance of specific and definite triggers for the development of signs and symptoms, for example, cold in cold urticaria, can reduce disease activity.
Nevertheless, since the highest safety is mandatory in pregnancy, the suggestion for the use of modern 2nd generation H1‑antihistamines is to prefer loratadine with the possible extrapolation to desloratadine and cetirizine with a possible extrapolation to levocetirizine.
1st generation H1‑antihistamines should be avoided.
In general, use of any systemic treatment should generally be avoided in pregnant women, especially in the first trimester.
The goal of treatment is to treat the disease until it is gone and as efficiently and safely as possible aiming at a continuous UAS7 = 0, complete control and a normalization of quality of life.
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