What is your experience managing patients with chronic spontaneous urticaria occurring only at night?  

Female in her early 40s with chronic spontaneous urticaria occurring consistently only at night for the past 4 years. Lesions develop only at night when the patient reports she is relaxed, sitting, and warm. Areas resolve spontaneously within 30 minutes to 1 hour. No similar episodes occurred during the day. Per patient photos, the lower back and bilateral thighs were affected with bright pink annular edematous plaques with a pale center consistent with urticaria. Prior patch testing positive for allergies to nickel and confectioner's glaze, which the patient diligently avoids. Medical history notable for Graves. Labs largely within normal limits, excluding thyroid labs. Previously trialed Xolair 300mg and dapsone without improvement. Antihistamine regimen led to improvement of symptoms but unable to continue due to dry eyes side effect in setting of history of Graves ophthalmopathy. Dupixent denied by insurance. Currently planning to trial Xolair 600mg Q4 weeks. 

Has anyone had a patient who develop urticarial lesions only occurring at night? Could a biochemical or circadian input be contributory?