Urticaria in Pregnancy and Lactation.

Area of Science:

• Immunology
• Dermatology
• Obstetrics

Background:

• Chronic urticaria (CU) is a mast cell-driven condition with female predominance, often affecting women of reproductive age.
• Pregnancy involves significant hormonal and immune system changes that can influence chronic inflammatory diseases.
• Limited data exists on pregnancy's effect on CU and the safety of its medications during gestation.

Purpose of the Study:

• To review the impact of sex hormones and pregnancy-related immune changes on chronic urticaria.
• To discuss how pregnancy affects CU course and outcomes.
• To provide guidance on managing urticaria in pregnant and lactating individuals.

Main Methods:

• Review of existing literature on sex hormones, immune changes, and their effect on urticaria.
• Analysis of findings from the PREG-CU study regarding CU course during pregnancy.
• Evaluation of current treatment guidelines and safety data for urticaria medications in pregnancy.

Main Results:

• Chronic urticaria improves in approximately 50% of pregnant patients, worsens in 33%, and 40% experience flare-ups.
• Pregnancy-associated immune shifts and hormonal fluctuations can modulate CU activity.
• The PREG-CU study offers initial real-world data on CU treatment outcomes during pregnancy.

Conclusions:

• Pregnancy significantly alters chronic urticaria course in a substantial portion of patients.
• Current guidelines recommend antihistamines and omalizumab, but evidence for safety in pregnancy is limited.
• Further research is needed to establish evidence-based management strategies for urticaria during pregnancy and lactation.