Cold urticaria
ICD-10 L50.2 · ICD-11 EB01.1

Cold Urticaria in Pregnancy or Lactation When Updosed Antihistamine Has Not Achieved Full Symptom Control

Clinical Scenario

This protocol addresses cold urticaria in pregnant or breastfeeding women. Treatment decisions in this population require careful risk–benefit assessment; drugs that are contraindicated or not suitable in pregnancy must be avoided throughout.

Prior Treatment — Goal Not Reached

The previous step used an increased (updosed) dosage of a modern 2nd-generation H1-antihistamine — an option recommended only with caution in pregnancy, given the absence of dedicated safety studies. This protocol applies when that approach has not achieved the required treatment target: complete symptom control with a continuous UAS7 = 0 and a well-controlled disease state.

Next-Step Approach

When an updosed antihistamine is insufficient, an add-on biological agent is considered. Its use in pregnancy has been reported to be safe, with no indication of teratogenicity to date. The complete criteria for selection, the full treatment pathway, and monitoring considerations remain in the structured protocol.

Target: continuous UAS7 = 0 · complete disease control
Instant Access to Structured Evidence-Based Regimens

References

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 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 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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