Cold urticaria during pregnancy or lactation requires a cautious, step-by-step approach in which risk–benefit assessment guides every decision. When the initial treatment line falls short of complete control, a defined next step exists for this specific population.
The patient is pregnant or breastfeeding and presents with persistent cold urticaria that has not reached the treatment target on the first line of therapy. The same treatment algorithm applies with caution in both pregnant and lactating women, and drugs that are contraindicated or not suitable in pregnancy are excluded.
The prior line — cold-exposure avoidance combined with a standard-dosed modern 2nd generation H1-antihistamine (preferring loratadine, with avoidance of 1st generation agents and systemic treatments, especially in the first trimester) — did not achieve the target of complete symptom control: a continuous UAS7 = 0 with absence of wheals and angioedema. The protocol below addresses what to do next.
Complete symptom control with a continuous UAS7 = 0 and a well-controlled disease state — aiming at complete control and normalization of quality of life.
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.
The increased dosage of modern 2nd generation H1-antihistamines can only be carefully suggested in pregnancy since safety studies have not been done, and with loratadine, it must be remembered that this drug is metabolized in the liver which is not the case for its metabolite desloratadine.
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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