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. 2025 Apr;155(4):1290-1298.
doi: 10.1016/j.jaci.2024.11.036. Epub 2024 Dec 13.

Mortality in adult patients with chronic spontaneous urticaria: A real-world cohort study

Pavel Kolkhir  1 , Katja Bieber  2 , Tomasz Hawro  3 , Khalaf Kridin  4 , Marlene A Ludwig  5 , Henning Olbrich  6 , Martin Metz  7 , Artem Vorobyev  6 , Ralf J Ludwig  8 , Marcus Maurer  7
Affiliations
Free article

Mortality in adult patients with chronic spontaneous urticaria: A real-world cohort study

Pavel Kolkhir et al. J Allergy Clin Immunol. 2025 Apr.
Free article

Abstract

Background: Chronic spontaneous urticaria (CSU), a common and debilitating disease, is widely held not to be life limiting, but the mortality of CSU has not been investigated.

Objective: We sought to assess all-cause mortality in patients with CSU, risk for comorbidities that are leading causes of death, and impact of guideline-recommended urticaria treatments on mortality rates.

Methods: This was a retrospective population-based cohort study of electronic health records of 272,190 adult patients with CSU and 12,728,913 controls without urticaria from the US collaborative network TriNetX.

Results: The study included 264,680 propensity score-matched patients with CSU (mean [SD] age = 47.5 [19.8] years; 71.5% female) and a corresponding number of controls without urticaria. Patients with CSU had higher 3-month (hazard ratio [HR] 2.10, 95% CI 1.97-2.22), 1-year (HR 1.77, 95% CI 1.71-1.83), and 5-year (HR 1.69, 95% CI 1.65-1.73) all-cause mortality (all P < .0001). Compared with controls, patients with CSU exhibited higher risk and rates of the leading causes of death in the United States, including suicidal ideations/suicide attempts (HR 3.14, 95% CI 3.00-3.28) and malignant neoplasms (HR 2.09, 95% CI 2.02-2.16). The risk of mortality appeared to be more pronounced in White and younger patients with CSU. All-cause mortality rates at 5 years were significantly lower in patients treated with second-generation H1 antihistamines versus untreated patients (1.0% vs 2.3%; HR 1.84, P < .0001) and omalizumab-treated patients versus antihistamine-treated patients (0.7% vs 2.6%; HR 3.99, P = .0003).

Conclusions: CSU is associated with increased mortality likely due to comorbidities, especially suicide, and effective CSU treatment may reduce mortality. These findings should be investigated in additional studies and in other populations.

Keywords: Chronic spontaneous urticaria; comorbidities; mortality; suicide; treatment.

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Conflict of interest statement

Disclosure statement This work was supported by Cluster of Excellence Precision Medicine in Chronic Inflammation Grant EXC 2167 and Individual Research Grant LU 877/25-1, both from the Deutsche Forschungsgemeinschaft, and the Schleswig-Holstein Excellence-Chair Program from the State of Schleswig-Holstein. Disclosure of potential conflict of interest: P. Kolkhir was a speaker/consultant and/or advisor for and/or has received research funding from Novartis, ValenzaBio, and Roche outside of the submitted work. K. Bieber has received honoraria or funding from Alpine Immune. T. Hawro was a speaker/consultant and/or advisor for and/or has received research funding from Novartis, Leo Pharma, and Sanofi outside of the submitted work. M. Metz is or recently was a speaker and/or advisor for AbbVie, Allmiral, ALK-Abello, Amgen, AstraZeneca, argenx, Bayer, Beiersdorf, Celldex, Celltrion, Escient, Galderma, GSK, Incyte, Jasper, Novartis, Pharvaris, Pfizer, Regeneron, Sanofi, Teva, Third Harmonic Bio, and Vifor. R. J. Ludwig has received honoraria for speaking or consulting or has obtained research grants from Monasterium Laboratories, Alpine Immune, Novartis, Lilly, Bayer, Dompe, Synthon, argenx, TriNetX, and Incyte during the last 3 years. R. J. Ludwig has received honoraria for speaking or consulting or has obtained research grants from Monasterium Laboratories, Alpine Immune, Novartis, Lilly, Bayer, Dompe, Synthon, argenx, TriNetX, and Incyte during the last 3 years. M. Maurer is or recently was a speaker and/or advisor for and/or has received research funding from Allakos, Alexion, Alvotech, Almirall, Amgen, Aquestive, argenx, AstraZeneca, Celldex, Celltrion, Clinuvel, Escient, Evommune, Excellergy, GSK, Incyte, Jasper, Kashiv, Kyowa Kirin, Leo Pharma, Lilly, Menarini, Mitsubishi Tanabe Pharma, Moxie, Noucor, Novartis, Orion Biotechnology, Resoncance Medicine, Sanofi/Regeneron, Santa Ana Bio, Septerna, Servier, Third Harmonic Bio, ValenzaBio, Vitalli Bio, Yuhan Corporation, and Zurabio. The rest of the authors declare that they have no relevant conflicts of interest.

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