The link between chronic spontaneous urticaria and metabolic syndrome

Veña, Gino Antonio; Cassano, Nicoletta

doi:10.23822/eurannaci.1764-1489.12

Cited by 19 publications

(15 citation statements)

References 31 publications

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“…In particular, AD is associated with allergic disorders representing the ‘atopic march’, 23 whereas PSO and CU are significantly associated with psoriatic arthritis on the one hand and thyroid autoimmunity on the other 24,25 . Despite a lower rate of cardiovascular risk factors and disorders in our AD cohorts compared with PSO and CU patients, associations with cardiovascular and neuropsychiatric comorbidities, potentially related to systemic inflammation, may also affect patients with AD 26‐30 . Thus, recent insights into the systemic nature 31 of AD eclipse the misconception that AD is just a ‘skin‐deep’ condition and will probably impact the AD therapeutic management 32 …”

Section: Discussionmentioning

confidence: 90%

Therapeutic management of adults with atopic dermatitis: comparison with psoriasis and chronic urticaria

Pascal

Maucort‐Boulch

Gilibert

et al. 2020

Acad Dermatol Venereol

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Background The therapeutic options in atopic dermatitis rely on consensus-based guidelines, also established for psoriasis and chronic urticaria. However, the therapeutic approach in atopic dermatitis, especially in the moderateto-severe forms of the disease, seems less aggressive than in psoriasis and in chronic urticaria with a less frequent use of systemic agents. Objectives To compare in real-life conditions the therapeutic management of adults with atopic dermatitis with those with psoriasis and chronic urticaria. Methods A transversal analysis was performed in May 2017, using retrospective data from a monocentric database. Data on epidemiology, severity, therapeutic educational intervention and systemic treatments were analysed from 401 patients with atopic dermatitis, compared with data from 230 patients with chronic urticaria and 535 patients with psoriasis. Results A high proportion (73%) of atopic dermatitis patients presented with a moderate-to-severe form of the disease compared to only 39% of chronic urticaria and 17% of psoriasis patients. Most of atopic dermatitis patients (78%) had completed a therapeutic educational programme, while the adherence was lower in chronic urticaria (35%) and in psoriasis (3%) patients. A systemic treatment, including biologicals, was recorded in 8% of atopic dermatitis patients, while it concerned 26% and 47% of chronic urticaria and psoriasis patients, respectively. Conclusions We confirmed that atopic dermatitis treatment mostly relies on topical treatments. Only a minority of moderate-to-severe atopic dermatitis patients who are eligible for a systemic treatment receive such therapy. This may suggest promoting a more frequent use of systemic agents in moderate-to-severe atopic dermatitis.

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Section: Discussionmentioning

confidence: 90%

Therapeutic management of adults with atopic dermatitis: comparison with psoriasis and chronic urticaria

Pascal

Maucort‐Boulch

Gilibert

et al. 2020

Acad Dermatol Venereol

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“…Several large studies have shown an association of CSU with hypertension and obesity (> 20%), 13,19–21 and a few also report a higher frequency of both hyperlipidaemia and metabolic syndrome 107,108 …”

Section: The Burden Of Chronic Urticaria Comorbiditiesmentioning

confidence: 99%

“…31 Several large studies have shown an association of CSU with hypertension and obesity (> 20%), 13,[19][20][21] and a few also report a higher frequency of both hyperlipidaemia and metabolic syndrome. 107,108 Given the debilitating nature of CSU, it is not surprising that >30% of patients experience psychiatric comorbidities including anxiety, depression and somatoform disorders, with a significant negative impact on their QoL. 13,20,109,110 An association between CSU and headaches has been reported, which can affect QoL, particularly in children.…”

Section: Angio-oedema Further Deteriorates Health-related Quality Of mentioning

confidence: 99%

The global burden of chronic urticaria for the patient and society*

et al. 2020

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Summary Chronic urticaria (CU) affects about 1% of the world population of all ages, mostly young and middle‐aged women. It usually lasts for several years (> 1 year in 25–75% of patients) and often takes > 1 year before effective management is implemented. It presents as chronic spontaneous urticaria (CSU), chronic inducible urticaria (CIndU) or both in the same person. More than 25% of cases are resistant to H1‐antihistamines, even at higher doses, and third‐ and fourth‐line therapies (omalizumab and ciclosporin) control the disease only in two‐thirds of H1‐antihistamine‐resistant patients. Here we review the impact of CU on different aspects of patients’ quality of life and the burden of this chronic disease for the patient and society. CU may have a strong impact on health‐related quality of life (HRQoL), particularly when CSU is associated with angio‐oedema and/or CIndU (Dermatology Life Quality Index > 10 in 30% of patients). Comorbidities, such as anxiety and depression, which are present in more than 30% of patients with CSU, compound HRQoL impairment. Severe pruritus and the unpredictable occurrence of weals and angio‐oedema are responsible for sleep disorders; sexual dysfunction; limitations on daily life, work and sports activities; interfering with life within the family and in society; and patients’ performance at school and work (6% absenteeism and 25% presenteeism). Apart from treatment costs, with annual values between 900 and 2400 purchasing power parity dollars (PPP$) in Europe and the USA, CU is associated with a high consumption of medical resources and other indirect costs, which may reach a total annual cost of PPP$ 15 550.

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“…Chronic low grade inflammation associated with high stress scores, raised C-reactive protein and interleukin 18 [84] may explain the increased frequency of metabolic syndrome in CSU [88, 89]. Hypertension was noted in 18.1% of the 1539 CSU patients that were analysed as part of the German contribution to the AWARE study [90].…”

Section: Aetiological and Associated Factors In Csumentioning

confidence: 99%

Stress, pseudoallergens, autoimmunity, infection and inflammation in chronic spontaneous urticaria

Bansal

2019

Allergy Asthma Clin Immunol

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Chronic spontaneous urticaria (CSU) is often associated with organ specific autoimmunity but is rarely caused by food allergy. Colourings and preservatives in pre-packaged foods, so called pseudoallergens, have also been implicated. Factors that promote inflammation or reduce anti-inflammatory mechanisms may however, predispose susceptible individuals to CSU. Chronic underlying infection and mental and emotional stress can sometimes precede the onset of CSU and once established can exacerbate the symptoms. There is early evidence of dysbiosis within the gastrointestinal tract in people with CSU and reduced levels of vitamin D are also evident. The latter may be related to the importance of vitamin D3 in increasing T regulatory function which can control a tendency to autoimmunity. It is quite possible that a state of on-going chronic inflammation with reduced anti-oxidant mechanisms may underlie the not infrequent association between CSU and metabolic syndrome. Effective treatment of CSU should involve the use of anti-histamines, intermittent steroids and anti-IgE therapy. For recalcitrant disease immune modulatory therapy has a place. However, talking therapies that reduce stress and anxiety, vitamin D3 supplementation, correction of intestinal dysbiosis and treatment of any chronic infection should also be considered.

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The link between chronic spontaneous urticaria and metabolic syndrome

Cited by 19 publications

References 31 publications

Therapeutic management of adults with atopic dermatitis: comparison with psoriasis and chronic urticaria

Therapeutic management of adults with atopic dermatitis: comparison with psoriasis and chronic urticaria

The global burden of chronic urticaria for the patient and society*

Stress, pseudoallergens, autoimmunity, infection and inflammation in chronic spontaneous urticaria

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