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Centre of Evidence of Dermatology Best practice guidelines

Guidelines chronic spontaneous urticaria Updated on december 2019

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Treatment of chronic spontaneous urticaria and pregnancy

Back to decision-making tree Print last updated on 18/09/2020

Patient picture
urticaria

Presentation

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

What do you suggest?

See proposition

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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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