D2.244 - Case Report: Postpartum Chronic Spontaneus Urticaria

Background:Chronic urticaria (CU) is a mast-cell–mediated inflammatory disorder that predominantly affects women of reproductive age. Hormonal and immunological changes during pregnancy and the postpartum period may influence CU disease onset and activity.

Case Presentation:We present a case of 29 years old previously healthy woman, who developed recurrent pruritic wheals in the early postpartum period persisting for more than nine weeks. Symptoms began 2 days after delivery and occurred daily without identifiable external triggers. This was first pregnancy, natural delivery, no medication involved. There was no personal or family history of urticaria, autoimmune disease, or atopy. Laboratory evaluation showed no evidence of infection, thyroid disfunction, or systemic autoimmune disease. Biochemical blood test were normal, hemogram normal with noted  eosinopenia and basopenia (both 0.00 K/µL), TSH 2.04µIU/mL, FT4 1.15 ng/mL, negative Anti-TPO and anti-TG antibodies < 1 IU/mL, Tryptase 10 ug/L, ERS 6 mm/h, PCR 0.31 mg/dl, FR 15 IU/mL, C3 170 mg/dl, C4 48 mg/dl, Helicobacter in faeces Ag negative, total IgE < 20 kU/L, ( sIgE negative for aeroallergen and  food allergens).  Based on clinical presentation and duration, a diagnosis of chronic spontaneous urticaria was established.

Management and Outcome: Due to steroids received first week post-partum, and psychological conditions, breastfeeding was stopped at few days post-partum. The patient was treated with second-generation H1-antihistamines at standard and subsequently increased doses up 3-fold/day with good clinical response. Symptoms gradually improved over time, with no adverse effects reported. After nine weeks, the chronic urticaria entered stable remission, which has been maintained for over six months. This case highlights the potential role of postpartum immune changes in triggering CU.

Conclusion:Postpartum chronic urticaria is an underrecognized clinical entity. Increased awareness and further real-life studies are needed to better understand disease mechanisms, optimal management, and medication safety in the postpartum setting.