Treatment patterns and outcomes in patients with chronic urticaria during pregnancy: Results of PREG-CU, a UCARE study
Emek Kocatürk 1 2 3, Mona Al-Ahmad 4, Karoline Krause 2 3, Ana M Gimenez-Arnau 5, Simon Francis Thomsen 6, Niall Conlon 7, Alexander Marsland 8, Ekin Savk 9, Roberta F Criado 10, Inna Danilycheva 11, Daria Fomina 12 13, Kiran Godse 14, Maryam Khoshkhui 15, Aslı Gelincik 16, Ece Nur Degirmentepe 17, Semra Demir 16, Luis Felipe Ensina 18, Alicja Kasperska-Zajac 19, Michael Rudenko 20, Solange Valle 21, Iris Medina 22, Andrea Bauer 23, Zuotao Zhao 24, Petra Staubach 25, Laurence Bouillet 26, Özlem Su Küçük 27, Arzu Baygül 28, Marcus Maurer 2 3
Affiliations
Affiliations
- Department of Dermatology, Urticaria Center of Reference, and Excellence (UCARE), Koç University School of Medicine, Istanbul, Turkey.
- Institute of Allergology, Urticaria Center of Reference and Excellence (UCARE), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany.
- Microbiology Department, Faculty of Medicine, Urticaria Center of Reference, and Excellence (UCARE), Kuwait University, Safat, Kuwait.
- Department of Dermatology, Urticaria Center of Reference, and Excellence (UCARE), Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, Spain.
- Department of Dermatology, Urticaria Center of Reference, and Excellence (UCARE), Bispebjerg Hospital, Copenhagen, Denmark.
- Department of Immunology, Urticaria Center of Reference and Excellence (UCARE), St. James's Hospital, Dublin and Trinity College, Dublin, Ireland.
- Department of Dermatology, Urticaria Center of Reference, and Excellence (UCARE), The Urticaria Clinic, Salford Royal Foundation Trust, University of Manchester, Manchester, UK.
- Aydın Adnan Menderes University, Aydın, Turkey.
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Faculdade de Medicina do ABC (FMABC), Santo André, Brazil.
- NRC Institute of Immunology, FMBA of Russia, Moscow, Russia.
- First Moscow State Medical University, Moscow, Russia.
- Urticaria Center of Reference and Excellence (UCARE), Moscow Center of Allergy and Immunology, Clinical Hospital 52, Ministry of Moscow Healthcare, Moscow, Russia.
- Dr. D.Y. Patil Medical College & Hospital, Mumbai, India.
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
- Okmeydani Training and Research Hospital, Istanbul, Turkey.
- Federal University of São Paulo, Sao Paulo, Brazil.
- European Center for Diagnosis and Treatment of Urticaria (GA2LEN UCARE Network), Medical University of Silesia in Katowice, Katowice, Poland.
- The London Allergy & Immunology Centre, London, UK.
- Federal University of Rio de Janeiro, Rio De Janeiro, Brazil.
- The Centro Médico Vitae, Buenos Aires, Argentina.
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
- Department of Dermatology and Venerology, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses and National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, China.
- Department of Dermatology, University Medical Center, Mainz, Germany.
- CHU de Grenoble Alpes, Grenoble, France.
- Department of Dermatology and Venerology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey.
- Department of Biostatistics, Koç University School of Medicine, Istanbul, Turkey.
Abstract
Background: Although chronic urticaria (CU) is a common and primarily affects females, there is little data on how pregnancy interacts with the disease.
Objective: To analyse the treatment use by CU patients before, during and after pregnancy as well as outcomes of pregnancy.
Methods: PREG-CU is an international, multicentre study of the Urticaria Centers of Reference and Excellence network. Data were collected via a 47-item-questionnaire completed by CU patients who became pregnant during their disease course.
Results: Questionnaires from 288 CU patients from 13 countries were analysed. During pregnancy, most patients (60%) used urticaria medication including standard-dose second generation H1-antihistamines (35.1%), first generation H1-antihistamines (7.6%), high-dose second-generation H1-antihistamines (5.6%) and omalizumab (5.6%). The preterm birth rate was 10.2%; rates were similar between patients who did and did not receive treatment during pregnancy (11.6% vs. 8.7%, respectively). Emergency referrals for CU and twin birth were risk factors for preterm birth. The caesarean delivery rate was 51.3%. More than 90% of new-borns were healthy at birth. There was no link between any patient or disease characteristics or treatments and medical problems at birth.
Conclusion: Most CU patients used treatment during pregnancy especially second-generation antihistamines which seem to be safe during pregnancy regardless of the trimester. The rates of preterm births and medical problems of new-borns in CU patients were similar to population norms and not linked to treatment used during pregnancy. Emergency referrals for CU increased the risk of preterm birth and emphasize the importance of sufficient treatment to keep urticaria under control during pregnancy.
Similar articles
Clinical experience of a specialized urticaria outpatient clinic from a Portuguese UCARE.
Esteves Caldeira L, Paulino M, Coutinho C, Neto M, Pereira Barbosa M, Costa C.Eur Ann Allergy Clin Immunol. 2023 Jan;55(1):9-18. doi: 10.23822/EurAnnACI.1764-1489.209. Epub 2021 May 5.PMID: 33949172
Effects of pregnancy on chronic urticaria: Results of the PREG-CU UCARE study.
Kocatürk E, Al-Ahmad M, Krause K, Gimenez-Arnau AM, Thomsen SF, Conlon N, Marsland A, Savk E, Criado RF, Danilycheva I, Fomina D, Godse K, Khoshkhui M, Gelincik A, Degirmentepe EN, Demir S, Ensina LF, Kasperska-Zajac A, Rudenko M, Valle S, Medina I, Bauer A, Zhao Z, Staubach P, Bouillet L, Küçük ÖS, Ateş C, Maurer M.Allergy. 2021 Oct;76(10):3133-3144. doi: 10.1111/all.14950. Epub 2021 Jun 12.PMID: 34022061
Chronic Urticaria: An Overview of Treatment and Recent Patents.
Hon KL, Leung AKC, Ng WGG, Loo SK.Recent Pat Inflamm Allergy Drug Discov. 2019;13(1):27-37. doi: 10.2174/1872213X13666190328164931.PMID: 30924425 Free PMC article. Review.
Ayse Ornek S, Orcen C, Church MK, Kocaturk E.Int Immunopharmacol. 2022 Nov;112:109198. doi: 10.1016/j.intimp.2022.109198. Epub 2022 Sep 15.PMID: 36115277
Current and future management of chronic spontaneous urticaria and chronic inducible urticaria.
Do TT, Canty EA, Joshi SR.Allergy Asthma Proc. 2023 Jan 1;44(1):3-14. doi: 10.2500/aap.2023.44.220093.PMID: 36719690 Review.
Cited by
Stepping Down Treatment in Chronic Spontaneous Urticaria: What We Know and What We Don't Know.
Terhorst-Molawi D, Fox L, Siebenhaar F, Metz M, Maurer M.Am J Clin Dermatol. 2023 May;24(3):397-404. doi: 10.1007/s40257-023-00761-z. Epub 2023 Feb 22.PMID: 36810982 Free PMC article. Review.
KMEL References
References
-
- Zuberbier T, Abdul Latiff AH, Abuzakouk M, Aquilina S, Asero R, Baker D, et al. The international EAACI/GA2LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy. 2022;77(3):734-66.
-
- Fricke J, Ávila G, Keller T, Weller K, Lau S, Maurer M, et al. Prevalence of chronic urticaria in children and adults across the globe: systematic review with meta-analysis. Allergy. 2020;75(2):423-32.
-
- Maurer M, Metz M, Bindslev-Jensen C, Bousquet J, Canonica GW, Church MK, et al. Definition, aims, and implementation of GA(2) LEN urticaria centers of reference and excellence. Allergy. 2016;71(8):1210-8.
-
- Kocatürk E, Al-Ahmad M, Krause K, Gimenez-Arnau AM, Thomsen SF, Conlon N, et al. Effects of pregnancy on chronic urticaria: results of the PREG-CU UCARE study. Allergy. 2021;76(10):3133-44.
-
- Walani SR. Global burden of preterm birth. Int J Gynaecol Obstet. 2020;150(1):31-3.
-
- Nielsen TF, Hökegård KH. The incidence of acute neonatal respiratory disorders in relation to mode of delivery. Acta Obstet Gynecol Scand. 1984;63(2):109-14.
-
- Tochie JN, Choukem SP, Langmia RN, Barla E, Koki-Ndombo P. Neonatal respiratory distress in a reference neonatal unit in Cameroon: an analysis of prevalence, predictors, etiologies and outcomes. Pan Afr Med J. 2016;24:152.
-
- Braun D, Braun E, Chiu V, Burgos AE, Gupta M, Volodarskiy M, et al. Trends in neonatal intensive care unit utilization in a large integrated health care system. JAMA Netw Open. 2020;3(6):e205239.
-
- Liao SL, Yu M, Zhao ZT, Maurer M. Case report: omalizumab for chronic spontaneous urticaria in pregnancy. Front Immunol. 2021;12:652973.
-
- Namazy JA, Blais L, Andrews EB, Scheuerle AE, Cabana MD, Thorp JM, et al. Pregnancy outcomes in the omalizumab pregnancy registry and a disease-matched comparator cohort. J Allergy Clin Immunol. 2020;145(2):528-36.e521.
-
- Palmsten K, Bandoli G, Vazquez-Benitez G, Xi M, Johnson DL, Xu R, et al. Oral corticosteroid use during pregnancy and risk of preterm birth. Rheumatology (Oxford). 2020;59(6):1262-71.
-
- Williams A, Grantz K, Seeni I, Robledo C, Li S, Ouidir M, et al. Obstetric and neonatal complications among women with autoimmune disease. J Autoimmun. 2019;103:102287.
-
- Trønnes H, Wilcox AJ, Markestad T, Tollånes MC, Lie RT, Moster D. Associations of maternal atopic diseases with adverse pregnancy outcomes: a national cohort study. Paediatr Perinat Epidemiol. 2014;28(6):489-97.
-
- Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and National Estimates: 1990-2014. PLoS ONE. 2016;11(2):e0148343.