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. 2017 Sep-Oct;5(5):1314-1318.
doi: 10.1016/j.jaip.2016.11.037. Epub 2017 Mar 14.

Chronic Idiopathic Urticaria: Systemic Complaints and Their Relationship with Disease and Immune Measures

Judy C Doong  1 , Kris Chichester  2 , Eric T Oliver  2 , Lawrence B Schwartz  3 , Sarbjit S Saini  4
Affiliations

Chronic Idiopathic Urticaria: Systemic Complaints and Their Relationship with Disease and Immune Measures

Judy C Doong et al. J Allergy Clin Immunol Pract. 2017 Sep-Oct.

Abstract

Background: Patients with chronic idiopathic urticaria (CIU)/chronic spontaneous urticaria sometimes report systemic complaints (SCs).

Objective: We sought to determine the frequency and characteristics of SCs among patients with CIU, as well as the association of SCs with disease measures, basophil histamine release, and serum tryptase.

Methods: Adult patients with CIU were recruited from a university allergy clinic. Patients completed a disease symptom survey and underwent blood sampling for subsequent basophil histamine release and serum tryptase measurement.

Results: A total of 155 patients with CIU were surveyed, with 103 reporting SCs with concomitant hives as follows: joint pain or swelling (55.3%), headache/fatigue (47.6%), flushing (42.7%), wheezing (30.1%), gastrointestinal complaints (26.2%), and palpitations (9.7%). Patients with SCs (CIU-SC) were compared with those with no SCs (CIU-NSC). Both groups had similar demographic characteristics (average age in 40s, majority female and white) and basophil histamine release profiles. CIU-SC had significantly greater disease duration (51.5% CIU-SC vs 30.8% CIU-NSC had >4 years duration), emergency department visits (41.7% vs 23.1% had >1 visit in the last year), CIU-related work absences (65% vs 27.5% had >1 day), oral corticosteroid use (84.5% vs 59.6%), quality-of-life impairment (76.1 vs 59.2 SkinDex score), and serum tryptase levels (5.1 ng/mL vs 3.9 ng/mL).

Conclusions: Despite similar demographic characteristics and basophil profiles as patients with CIU-NSC, patients with CIU-SC have features of greater disease burden (work absences, emergency department visits, and corticosteroid use), quality-of-life impairment, and baseline serum tryptase levels.

Keywords: Chronic idiopathic urticaria; Chronic spontaneous urticaria; Histamine; Quality of life; Systemic complaints; Tryptase.

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Conflict of interest statement

Conflicts of interest: L. B. Schwartz has received travel support from the National Institutes of Health; has received consultancy fees from SanofiAventis, Dyax, ViroPharma, and HELIX; has received research support from CSL Behring, Dyax/Shire, and Merck; shared royalties with VCU Tech Transfer, which received them from ThermoFisher for the tryptase assay; and has received payment to participate in the Atopic Dermatitis in America study from Asthma and Allergy Foundation of America. S. S. Saini has received consultancy fees from AstraZeneca and Teva and receives royalties from UpToDate. The rest of the authors declare that they have no relevant conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
SCs frequency based on number of systems reported. Out of 155 patients with CIU, 52 (34%) reported not having SCs, 43 (28%) reported 1 SC, 29 (19%) reported 2 SCs, 16 (10%) reported 3 SCs, 8 (5%) reported 4 SCs, 5 (3%) reported 5 SCs, and 2 (1%) reported 6 SCs with concomitant hives.
FIGURE 2.
FIGURE 2.
Frequency of individual SCs in the CIU-SC group. Out of 103 patients with CIU with SCs, 57 (55.3%) reported joint pain or swelling, 49 (47.6%) reported headache or fatigue, 44 (42.7%) reported flushing, 31 (30.1%) reported wheezing or breathlessness, 27 (26.2%) reported gastrointestinal complaints, and 10 (9.7%) reported palpitations.
FIGURE 3.
FIGURE 3.
Serum tryptase levels relative to current itch score. A total of 114 subjects (78 CIU-SC and 36 CIU-NSC) had serum sample collected at the time of survey, and the resulting serum tryptase level is plotted against the itch score reported at the time of the survey with correlation coefficient 0.23.
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