Unraveling the Complex Nexus of Chronic Spontaneous Urticaria: Immunological, Infectious and Psychosomatic Dimensions

Authors: Duda-Cebula E, Szwajca K, Śmierciak N*, Szwajca M, Kudła K and Pilecki M

DOI: 10.23880/pprij-16000374

Volume 8, Issue 4

Abstract

Chronic Spontaneous Urticaria (CSU) is a complex dermatologic allergic condition characterized by unknown origins, frequent relapses, and resistance to therapy, contributing to a substantial psychosocial burden. Stressful experiences appear to coincide with CSU onset and exacerbation, suggesting a psychosomatic element within a psychoneuroimmunological framework. The condition significantly impairs patients’ quality of life, disrupting daily activities and exhibiting a high prevalence of psychiatric comorbidities. Recent theories propose autoantibodies activating mast cells as a potential key factor in CSU development. Psychological stress is considered both a trigger for CSU onset and a factor influencing the disease course and therapy effectiveness. Although the skin’s response mechanisms to psychological stress are not fully understood, inflammatory mediators, neuropeptides, and neurotransmitters are believed to play a role. Chronic Spontaneous Urticaria (CSU) is estimated to impact 0.5–1% of the global population at any given time, making up approximately two-thirds of all Chronic Urticaria (CU) cases. Among individuals with CSU/CIU, it is suggested that 33–67% experience both itchy welts and deeper skin swelling, while 29–65% solely have itchy welts, and 1–13% exclusively experience deeper skin swelling. Despite extensive research on the clinical aspects and origin of CSU/CIU in the last decade, the comprehensive understanding of the humanistic and economic implications of CSU/CIU remains unclear, especially for those with an inadequate response to initial treatment strategies. Research indicates that infections act as a facilitating factor for CSU initiation and perpetuation, with stress potentially necessary for the expression of the CSU phenotype. Detection and treatment of hidden infections have shown improvements in CSU patients, reinforcing the association between infections and CSU. A comprehensive, multidisciplinary approach that considers biological, psychological, and social aspects is emphasized for effective urticaria treatment. Current research underscores the significant psychological impact of CSU, particularly for individuals with more severe forms or those diagnosed with chronic autoimmune urticarial.

Keywords: Urticaria; Psychological Aspects; Immunology

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