What causes chronic urticaria?

Updated: Jul 31, 2018
  • Author: Marla N Diakow, MD; Chief Editor: William D James, MD  more...
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A number of different etiologic factors have been reported as proposed causes of chronic urticaria.

Autoimmunity is thought to be one of the most frequent causes of chronic urticaria. Various autoimmune or endocrine diseases have been associated with urticaria, including systemic lupus erythematosus, cryoglobulinemia, juvenile rheumatoid arthritis, and autoimmune thyroid disease (eg, Graves disease). [12, 13]

Several cross-sectional studies have investigated whether patients with chronic urticaria are more prone to autoimmune disorders. Ryhal et al compared 25 patients with urticaria with 75 subjects being treated for other conditions and found that antibodies to thyroid peroxidase (also known as thyroid microsomal antibody) and rheumatoid factor were more common in patients with chronic urticaria (P < .01 and P< .05, respectively) compared with controls. [14] However, no difference was reported in the prevalence of other autoantibodies, such as anti-sDNA, anti-Ro/anti-La ribonucleic acid antibodies, anti-cardiolipin, anti–β2-glycoprotein 1, antimyeloperoxidase, anti–proteinase 3, anti–smooth muscle, and antinuclear antibodies, between the two groups. These data imply that broad nonspecific autoantibodies are not commonly found in patients with chronic urticaria.

There is a significant association of chronic urticaria with thyroid autoimmunity, and antithyroid autoantibodies are significantly increased in patients with chronic urticaria. The prevalence of thyroid autoimmunity among chronic urticaria patients varies from 4.3% to 57% in the literature, and about 5-10% of chronic urticaria patients have abnormal thyroid function. [15] In one study comparing 70 patients with chronic urticaria with 70 healthy controls, it was found that 23-30% of patients with chronic urticaria had either or both antithyroglobulin antibody (anti-Tg) and antimicrosomal antibody (antithyroid peroxidase [TPO]), and as many as 5-10% had abnormal thyroid function. [15] A case control study detected similar rates of thyroid antibodies in chronic urticaria patients, detecting anti-TG positivity in 22% and anti-TPO positivity in 27% of chronic urticaria patients; 93% of patients had normal thyroid function. [16]

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