Chronic urticaria (CU) is a mast cell-driven chronic inflammatory disease with a female
predominance. Since CU affects mostly females in reproductive age, pregnancy is
an important aspect to consider in the context of this disease. Sex hormones affect
mast cell (MC) biology, and the hormonal changes that come with pregnancy can
modulate the course of chronic inflammatory conditions, and they often do. Also,
pregnancy-associated changes in the immune system, including local adaptation of
innate and adaptive immune responses and skewing of adaptive immunity toward a
Th2/Treg profile have been linked to changes in the course of inflammatory diseases.
As of now, little is known about the effects of pregnancy on CU and the outcomes of
pregnancy in CU patients. Also, there are no real-life studies to show the safety of urticaria
medications during pregnancy. The recent PREG-CU study provided the first insights on
this and showed that CU improves during pregnancy in half of the patients, whereas
it worsens in one-third; and two of five CU patients experience flare-ups of their CU
during pregnancy. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for
urticaria recommends adopting the samemanagement strategy in pregnant and lactating
CU patients; starting treatment with standard doses of second-generation (non-sedative)
H1 antihistamines, to increase the dose up to 4-folds in case of no response, and to
add omalizumab in antihistamine-refractory patients; but also emphasizes the lack of
evidence-based information on the safety and efficacy of urticaria treatments during
pregnancy. The PREG-CU study assessed treatments and their outcomes during
pregnancy. Here, we review the reported effects of sex hormones and pregnancy-specific
immunological changes on urticaria, we discuss the impact of pregnancy on urticaria, and
we provide information and guidance on the management of urticaria during pregnancy
and lactation.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:89042 |
| Date | 16 January 2024 |
| Creators | Kocatürk, Emek, Podder, Indrashis, Zenclussen, Ana C., Kasperska Zajac, Alicja, Elieh-Ali-Komi, Daniel, Church, Martin K., Maurer, Marcus |
| Publisher | Frontiers Media S.A. |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:article, info:eu-repo/semantics/article, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 892673 |
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