Can my daughter conceive with Hashimoto’s and urticaria?

Question

Hello doctor,

My 26-year-old daughter has had chronic urticaria for 14 months now, and we can not find what is causing it. The hives appear randomly all over her body and face, sometimes so swollen that her eyes are nearly shut. Her allergist tested for everything, but all came back negative. The attacks seem to get worse right before her menstrual cycle and during ovulation. She has been on antihistamines daily (Cetirizine 20 mg and Ranitidine 150 mg), but still gets breakthrough episodes. Her inflammatory markers are slightly elevated with CRP at 4.2 mg/L.

We discovered she also has Hashimoto's thyroiditis with TPO antibodies at 156 IU/mL, which might be connected to the urticaria. Prednisone helps, but she can not stay on it long-term because it is affecting her bone density. The hives are so unpredictable that she is afraid to leave the house or make plans. Her dermatologist mentioned autoimmune urticaria, but we need to know if this could affect her fertility plans. What treatments are safe for women planning a pregnancy?

Kindly suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

Chronic spontaneous urticaria (CSU) that lasts over six weeks without an identifiable trigger, especially when associated with Hashimoto’s thyroiditis and elevated TPO (thyroid peroxidase) antibodies, is often autoimmune.

This autoimmune urticaria can flare with hormonal changes, which explains why her symptoms worsen around ovulation and menstruation.
While standard antihistamines like Cetirizine and H2 blockers such as Ranitidine (though less commonly used now) can help, many patients with autoimmune urticaria need advanced treatment. A key option is Omalizumab (Xolair), a monoclonal antibody approved for chronic urticaria that is not responsive to antihistamines.
It has shown excellent results in reducing hives and swelling, and is considered relatively safe for women of childbearing age, though it should be discussed with her allergist or immunologist.
For women planning pregnancy, Omalizumab may still be used if the benefits outweigh the risks, and data so far have not shown major safety concerns, but careful monitoring is essential.
Steroids like Prednisone are effective for short-term relief, but, as you have noted, are not sustainable due to side effects like bone loss. Managing her thyroid disease is also crucial, as uncontrolled Hashimoto’s may worsen urticaria and affect fertility.

I hope this information will help you.

Kindly follow up if you have more concerns.

Thank you.