Urticaria in Pregnancy and Lactation

被引:16
作者
Kocaturk, Emek [1 ]
Podder, Indrashis [2 ,3 ]
Zenclussen, Ana C. [4 ,5 ]
Zajac, Alicja Kasperska [6 ,7 ]
Elieh-Ali-Komi, Daniel [8 ,9 ,10 ,11 ]
Church, Martin K. [11 ]
Maurer, Marcus [8 ,9 ,10 ,11 ]
机构
[1] Koc Univ, Dept Dermatol, Sch Med, Istanbul, Turkey
[2] Coll Med, Dept Dermatol Venereol & Leprosy, Kolkata, India
[3] Sagore Dutta Hosp, Kolkata, India
[4] Univ Leipzig, Helmholtz Ctr Environm Res UFZ, Dept Environm Immunol, Leipzig, Germany
[5] Univ Leipzig, Saxonian Incubator Clin Translat SIKT, Leipzig, Germany
[6] UCARE, European Ctr Diag & Treatment Urticar Angioedema, ACARE Network, GA2LEN, Zabrze, Poland
[7] Med Univ Silesia, Dept Clin Allergol, Urticar Ctr, Katowice, Poland
[8] Charite Univ Med Berlin, Inst Allergol, Berlin, Germany
[9] Free Univ Berlin, Berlin, Germany
[10] Humboldt Univ, Berlin, Germany
[11] Fraunhofer Inst Translat Med & Pharmacol ITMP, Allergol & Immunol, Berlin, Germany
来源
FRONTIERS IN ALLERGY | 2022年 / 3卷
关键词
urticaria; pregnancy; lactation; treatment; autoimmunity; immunological changes; mast cells; hormones; NATURAL-KILLER-CELLS; REGULATORY T-CELLS; HUMAN CHORIONIC-GONADOTROPIN; 1ST TRIMESTER EXPOSURE; ATOPIC-DERMATITIS; DENDRITIC CELLS; MAST-CELLS; CROSS-TALK; VITAMIN-D; SAFETY;
D O I
10.3389/falgy.2022.892673
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
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/GA(2)LEN/EuroGuiDerm/APAAACI guideline for urticaria recommends adopting the same management 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.
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页数:16
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