Non–Skin Related Symptoms Are Common in Chronic Spontaneous Urticaria and Linked to Active and Uncontrolled Disease: Results From the Chronic Urticaria Registry

Polina Pyatilova, Yana Hackler, Felix Aulenbacher, Riccardo Asero, Andrea Bauer, Mojca Bizjak, Cascia Day, Joachim Dissemond, Aurélie Du-Thanh, Daria Fomina, Ana M. Giménez-Arnau, Clive Grattan, Stamatis Gregoriou, Tomasz Hawro, Alicja Kasperska-Zajac, Maryam Khoshkhui, Emek Kocatürk, Elena Kovalkova, Kanokvalai Kulthanan, Elizaveta KuznetsovaMichael Makris, Olga Mukhina, David Pesqué, Jonny Peter, Pascale Salameh, Frank Siebenhaar, Agnieszka Sikora, Petra Staubach, Papapit Tuchinda, Mateusz Zamłyński, Karsten Weller, Marcus Maurer, Pavel Kolkhir

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Chronic spontaneous urticaria (CSU) can present with non–skin related symptoms (NSRS), including recurrent unexplained fever, joint, bone, or muscle pain (JBMP), and malaise, which also occur in other conditions that manifest with wheals (eg, urticarial vasculitis or autoinflammatory disorders) or without wheals (eg, infection). Objective: We sought to determine the rate of patients with CSU affected by fever, JBMP, and malaise, their trigger factors, links with clinical and laboratory characteristics, and their impact on everyday life and treatment responses. Methods: We analyzed baseline data from the Chronic Urticaria Registry of 2,521 patients with CSU who were aged 16 years or older. Results: One third of CSU patients (31.2%; 786 of 2,521) had one or more NSRS, including recurrent fever (5.3%), JBMP (19.1%), and/or malaise (18.6%). In a multivariable analysis, having one or more of these NSRS correlated with food and infection as trigger factors of urticaria (adjusted odds ratio [aOR] = 1.7 and 1.5), wheals of 24 hours or greater duration (aOR = 2.5), sleep disturbance (aOR = 2.4), anxiety (aOR = 2.8), comorbid atopic dermatitis (aOR = 2.1), gastrointestinal disease (aOR = 1.8), elevated leukocytes (aOR = 1.7) and erythrocyte sedimentation rate (aOR = 1.5). In a bivariate analysis, these NSRS were additionally associated with higher disease activity (weekly Urticaria Activity Score, median: 21 vs 14; P = .009), longer disease duration (years, median: 2 vs 1; P = .001), the presence of angioedema (74.6% vs 58.7%; P < .001), worse quality of life (Chronic Urticaria Quality of Life Questionnaire, median: 42 vs 29; P < .001) and more frequent poor control of CSU (78% vs 69%; P < .001). Conclusions: The presence of NSRS in a subpopulation of patients with CSU points to the need for better control of the disease, exclusion of comorbid conditions, and/or exclusion of urticarial vasculitis and urticarial autoinflammatory diseases.

Original languageEnglish
JournalJournal of Allergy and Clinical Immunology: In Practice
DOIs
Publication statusAccepted/In press - 2024
Externally publishedYes

Keywords

  • and muscle pain
  • bone
  • Chronic spontaneous urticaria
  • Fever
  • Joint
  • Malaise
  • Non–skin related symptoms

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