Chronic spontaneous urticaria clinical case 6, Centre of Evidence of Dermatology

Treatment of chronic spontaneous urticaria and pregnancy

Back to decision-making tree Print last updated on 21/02/2024

Presentation

Mrs A., 27 years old, consults for chronic spontaneous urticaria that has been ongoing for more than 3 years. The clinical examination is normal, apart from a few superficial urticarial patches. She has never had angioedema. She had a normal initial blood workup (CBC, CRP).

Previous treatments

She initially took various anti-H1 antihistamines at conventional doses (MA dose). For the past 2 years, she has been taking bilastine, the doses of which have been gradually increased to 3 doses per day. She explains that the outbreaks of urticaria have become less frequent, remain present, but currently cause her little discomfort.

Other elements

She is not on any other medication.
She has just stopped using birth control because she is planning to have a child.

What do you suggest?

See proposition

Proposition

Assessment

It is recommended to assess CSU activity using the UCT and UAS7 scores, as well as the impact of CSU on her quality of life (DLQI or CU-QoL scores); further management will depend on these assessments.

Treatment

There is no demonstrated predictive evidence regarding CSU during pregnancy. ^*Most experts interviewed reported that, in their experience, there is a tendency for CSU to improve during pregnancy, and sometimes to worsen after childbirth.
Choose anti-H1 antihistamines for which abundant and reassuring data in pregnant women exists: propose therefore to substitute bilastine by cetirizine or levocetirizine (www.lecrat.fr). These anti-H1 antihistamines may be continued during pregnancy, at the minimum effective dose. ^*Some experts suggest lowering the dosage to 2 or even 1 tablet per day near term (to avoid any risk of drowsiness in the newborn), others leave the anti-H1 antihistamine at the same dose during the whole pregnancy.
Breastfeeding is possible if desired. As anti-H1 antihistamines pass into the milk, find the minimum effective dose to avoid any risk of drowsiness in the infant.

References

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Centre of Evidence of Dermatology Best practice guidelines

Guidelines chronic spontaneous urticaria Updated on december 2019

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