This protocol is for pregnant and lactating women with cold urticaria whose disease remains uncontrolled after the previous treatment step. Managing cold urticaria in this population requires careful individual risk–benefit assessment, as therapeutic options must account for the safety of both the mother and the unborn child or nursing infant.
The same general treatment algorithm applies to pregnant and lactating women, but must be followed with caution. Drugs that are contraindicated or not suitable in pregnancy are excluded from consideration, and every treatment decision is guided by a thorough individual risk–benefit assessment.
The preceding treatment step employed add-on omalizumab, which has been reported to be safe in pregnancy with no indication of teratogenicity to date. Escalation to this protocol is indicated when omalizumab fails to meet the treatment goal: complete symptom control with a continuous UAS7 = 0 and a well-controlled disease state.
This protocol introduces a further add-on agent. Because of its specific safety profile in pregnancy, the decision to use it must be made individually for each patient rather than applied as a routine next step. The full protocol details the clinical criteria and safety context that guide that case-by-case determination.
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.
For example, ciclosporin, although not teratogenic, is embryo‑toxic in animal models and is associated with preterm delivery and low birth weight in human infants.
Whether the benefits of ciclosporin in CU are worth the risks in pregnant women will have to be determined on a case‑by‑case basis.
View source ↗