Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Clinical and Translational Allergy
Published in: Clinical and Translational Allergy 1/2019

Open Access 01-12-2019 | Mood Disorders | Review

Psychiatric comorbidity in chronic urticaria patients: a systematic review and meta-analysis

Authors: Gerasimos N. Konstantinou, George N. Konstantinou

Published in: Clinical and Translational Allergy | Issue 1/2019

Login to get access

Abstract

Background

Dermatological illness can affect the quality of life and may coexist with psychiatric disorders.

Objective

The aim of this review was to systematically evaluate the published evidence of any psychiatric disorders that may coexist with chronic urticaria (CU) and any effect psychiatric interventions may have on CU.

Methods

Following the Cochrane guidance, we conducted a systematic literature search using web-based search engines provided by PubMed (for Medline database), Google Scholar and Scopus for studies that have investigated the existence of psychiatric comorbidity in patients with CU. To be included, a study had to possess features, such as: (1) distinction between chronic urticaria and allergic conditions, (2) direct collection of diagnostic psychiatric data by using clinical interview and standardized questionnaires, (3) International Classification of Disorders criteria or the Diagnostic and Statistical Manual of Mental Disorders criteria for the diagnosis of mental disorders, and (4) manuscripts written or published in the English language. Unpublished research and research in progress were not included. All the eligible studies were scrutinized for any reported psychiatric interventions that had any effect on CU. The systematic review has been registered on PROSPERO (registration number CRD42019122811) and was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA).

Results

Twenty-five studies were identified. Almost one out of three CU patients have at least one underlying psychiatric disorder. None of the studies clarified whether the psychiatric disorders pre-existed the CU onset, and no association was found between CU severity and duration, and psychological functioning. Only one case report and two case series mentioned that treatment of psychiatric disorders with either anti-depressants, anti-anxiety drugs or psychological interventions might result in improvement of urticaria.

Conclusions

Patients with CU frequently experience psychiatric disorders. This highlights the need for a multidisciplinary therapeutic approach involving prompt recognition and management of any potential psychiatric disorder in addition to urticaria treatment. Further studies are needed to assess whether psychiatric disorders coexist with CU independently or follow urticaria onset and whether any psychological or psychiatric intervention may help in CU control.
Literature
1.
Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018;73(7):1393–414.PubMedCrossRef
2.
Altinoz AE, Taskintuna N, Altinoz ST, Ceran S. A cohort study of the relationship between anger and chronic spontaneous urticaria. Adv Ther. 2014;31(9):1000–7.PubMedCrossRef
3.
O’Donnell BF, Lawlor F, Simpson J, Morgan M, Greaves MW. The impact of chronic urticaria on the quality of life. Br J Dermatol. 1997;136(2):197–201.PubMedCrossRef
4.
Potocka A, Turczyn-Jablonska K, Merecz D. Psychological correlates of quality of life in dermatology patients: the role of mental health and self-acceptance. Acta Dermatovenerol Alp Pannonica Adriat. 2009;18(2):53–8, 60, 62.
5.
Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014;133(5):1270–7.PubMedCrossRef
6.
Czubalski K. Mental disorders in patients suffering from allergy. Psychiatr Pol. 1972;6:277–84.PubMed
7.
Drunkenmolle R. Neuropsychological findings in chronic urticaria. Dtsch Gesundheitsw. 1971;26:398–401.PubMed
8.
Koblenzer CS. Psychosomatic concepts in dermatology: a dermatologist-psychoanalyst’s viewpoint. Arch Dermatol. 1983;119:501–12.PubMedCrossRef
9.
Sperber J, Shaw J, Bruce S. Psychological components and the role of adjunct interventions in chronic idiopathic urticaria. Psychother Psychosom. 1989;51:135–41.PubMedCrossRef
10.
Clarke TW. The role of allergy in neuropsychiatry. Psychiatr Q. 1940;14:800–8.CrossRef
11.
Caccavale S, Bove D, Bove RM, Montagna LA. Skin and brain: itch and psychiatric disorders. G Ital Dermatol Venereol. 2016;151(5):525–9.PubMed
12.
Hergüner S, Kiliç G, Karakoç S, Tamay Z, Tüzün U, Güler N. Levels of depression, anxiety and behavioral problems and frequency of psychiatric disorders in children with chronic idiopathic urticaria. Br J Dermatol. 2011;164(6):1342–7.PubMedCrossRef
13.
Kuo CL, Chen CY, Huang HL, Chen WL, Lee HC, Chang CY, et al. Increased risk of major depression subsequent to a first-attack and non-infection caused urticaria in adolescence: a nationwide population-based study. BMC Pediatr. 2014;14:181.PubMedPubMedCentralCrossRef
14.
Lindsay K, Goulding J, Solomon M, Broom B. Treating chronic spontaneous urticaria using a brief ‘whole person’ treatment approach: a proof-of-concept study. Clin Transl Allergy. 2015;5:40.PubMedPubMedCentralCrossRef
15.
Broom BC. A reappraisal of the role of ‘mindbody’ factors in chronic urticaria. Postgrad Med J. 2010;86:365–70.PubMedCrossRef
16.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.PubMedPubMedCentralCrossRef
17.
Chu CY, Cho YT, Jiang JH, Lin EI, Tang CH. Epidemiology and comorbidities of patients with chronic urticaria in Taiwan: a nationwide population-based study. J Dermatol Sci. 2017;88(2):192–8.PubMedCrossRef
18.
Juhlin L. Recurrent urticaria: clinical investigation of 330 patients. Br J Dermatol. 1981;104:369–81.PubMedCrossRef
19.
Pulimood S, Rajagopalan B, Rajagopalan M, Jacob M, John JK. Psychiatric morbidity among dermatology inpatients. Natl Med J India. 1996;9:208–10.PubMed
20.
Picardi A, Abeni D, Melchi CF, Puddu P, Pasquini P. Psychiatric morbidity in dermatological outpatients: an issue to be recognized. Br J Dermatol. 2000;143(5):983–91.PubMedCrossRef
21.
Picardi A, Mazzotti E, Pasquini P. Prevalence and correlates of suicidal ideation among patients with skin disease. J Am Acad Dermatol. 2006;54:420–6.PubMedCrossRef
22.
Staubach P, Dechene M, Metz M, Magerl M, Siebenhaar F, Weller K, et al. High prevalence of mental disorders and emotional distress in patients with chronic spontaneous urticaria. Acta Derm Venereol. 2011;91(5):557–61.PubMedCrossRef
23.
Mehta V, Malhotra SK. Psychiatric evaluation of patients with psoriasis vulgaris and chronic urticaria. German J Psychiatry, 2007;10(4):104–10.
24.
Sorour F, Abdelmoaty A, Bahary M, El Birqdar B. Psychiatric disorders associated with some chronic dermatologic diseases among a group of Egyptian dermatology outpatient clinic attendants. J Egypt Women’s Dermatol Soc. 2017;14(1):31–6.CrossRef
25.
Atefi N, Rahimi M, Peyghambari S, Ghourchian S. Psychological status in patients with chronic urticaria. Med J Islam Repub Iran. 2011;25:200–4.
26.
Uguz F, Engin B, Yilmaz E. Axis I and axis II diagnoses in patients with chronic idiopathic urticaria. J Psychosom Res. 2008;64:225–9.PubMedCrossRef
27.
Staubach P, Eckhardt-Henn A, Dechene M, Vonend A, Metz M, Magerl M, et al. Quality of life in patients with chronic urticaria is differentially impaired and determined by psychiatric comorbidity. Br J Dermatol. 2006;154:294–8.PubMedCrossRef
28.
Ozkan M, Oflaz SB, Kocaman N, Ozseker F, Gelincik A, Büyüköztürk S, et al. Psychiatric morbidity and quality of life in patients with chronic idiopathic urticaria. Ann Allergy Asthma Immunol. 2007;99:29–33.PubMedCrossRef
29.
Lapi F, Cassano N, Pegoraro V, Cataldo N, Heiman F, Cricelli I, et al. Epidemiology of chronic spontaneous urticaria: results from a nationwide, population-based study in Italy. Br J Dermatol. 2016;174:996–1004.PubMedCrossRef
30.
Yang HY, Sun CC, Wu YC, Wang JD. Stress, insomnia, and chronic idiopathic urticaria—a case–control study. J Formos Med Assoc. 2005;104:254–63.PubMed
31.
Calikuşu C, Yücel B, Polat A, Baykal C. The relation of psychogenic excoriation with psychiatric disorders: a comparative study. Compr Psychiatry. 2003;44:256–61.PubMedCrossRef
32.
Chung MC, Symons C, Gilliam J, Kaminski ER. The relationship between posttraumatic stress disorder, psychiatric comorbidity, and personality traits among patients with chronic idiopathic urticaria. Compr Psychiatry. 2010;51:55–63.PubMedCrossRef
33.
Demet MM, Deveci A, Taskin EO, Ermertcan AT, Yurtsever F, Deniz F, et al. Obsessive–compulsive disorder in a dermatology outpatient clinic. Gen Hosp Psychiatry. 2005;27:426–30.PubMedCrossRef
34.
Sukan M, Maner F. The problems in sexual functions of vitiligo and chronic urticaria patients. J Sex Marital Ther. 2007;33:55–64.PubMedCrossRef
35.
36.
Bashir K, Dar NR, Rao SU. Depression in adult dermatology outpatients. J Coll Physicians Surg Pak. 2010;20:811–3.PubMed
37.
38.
Gupta MA, Gupta AK. Chronic idiopathic urticaria associated with panic disorder: a syndrome responsive to selective serotonin reuptake inhibitor antidepressants? Cutis. 1995;56:53–4.PubMed
39.
Gupta MA, Gupta AK. Chronic idiopathic urticaria and post-traumatic stress disorder (PTSD): an under-recognized comorbidity. Clin Dermatol. 2012;30:351–4.PubMedCrossRef
40.
Seyhan M, Aki T, Karincaoglu Y, Ozcan Η. Psychiatric morbidity in dermatology patients: frequency and results of consultations. Indian J Dermatol. 2006;51:18–22.CrossRef
41.
Perugi G, Quaranta G, Belletti S, Casalini F, Mosti N, Toni C, et al. General medical conditions in 347 bipolar disorder patients: clinical correlates of metabolic and autoimmune-allergic diseases. J Affect Disord. 2015;170:95–103.PubMedCrossRef
42.
Lyketsos CG, Lyketsos GC, Richardson SC, Beis A. Dysthymic states and depressive syndromes in physical conditions of presumably psychogenic origin. Acta Psychiatr Scand. 1987;76:529–34.PubMedCrossRef
43.
World Health Organization. Depression and other common mental disorders: global health estimates. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
44.
45.
Hein UR, Henz BM, Haustein UF, Seikowski K, Aberer W, Lautenschlager S, et al. Correlation between chronic urticaria and depression/somatization disorder. Hautarzt. 1996;47:20–3.PubMedCrossRef
46.
Sheehan-Dare RA, Henderson MJ, Cotterill JA. Anxiety and depression in patients with chronic urticaria and generalized pruritus. Br J Dermatol. 1990;123:769–74.PubMedCrossRef
47.
Consoli SG. Psychological factors in chronic urticaria. Ann Dermatol Venereol. 2003;130(Spec No 1):1s73–7.PubMed
48.
Gregoriou S, Rigopoulos D, Katsambas A, Katsarou A, Papaioannou D, Gkouvi A, et al. Etiologic aspects and prognostic factors of patients with chronic urticaria: nonrandomized, prospective, descriptive study. J Cutan Med Surg. 2009;13:198–203.PubMedCrossRef
49.
Ben-Shoshan M, Blinderman I, Raz A. Psychosocial factors and chronic spontaneous urticaria: a systematic review. Allergy. 2013;68:131–41.PubMedCrossRef
50.
Paus R, Theoharides TC, Arck PC. Neuroimmunoendocrine circuitry of the ‘brain–skin connection’. Trends Immunol. 2006;27:32–9.PubMedCrossRef
51.
Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull. 2004;130:601–30.PubMedPubMedCentralCrossRef
52.
Dalman C, Allebeck P, Gunnell D, Harrison G, Kristensson K, Lewis G, et al. Infections in the CNS during childhood and the risk of subsequent psychotic illness: a cohort study of more than one million Swedish subjects. Am J Psychiatry. 2008;165:59–65.PubMedCrossRef
53.
Eaton WW, Byrne M, Ewald H, Mors O, Chen CY, Agerbo E, et al. Association of schizophrenia and autoimmune diseases: linkage of Danish national registers. Am J Psychiatry. 2006;163:521–8.PubMedCrossRef
54.
Jones AL, Mowry BJ, Pender MP, Greer JM. Immune dysregulation and self-reactivity in schizophrenia: do some cases of schizophrenia have an autoimmune basis? Immunol Cell Biol. 2005;83:9–17.PubMedCrossRef
55.
Niebuhr DW, Millikan AM, Cowan DN, Yolken R, Li Y, Weber NS. Selected infectious agents and risk of schizophrenia among US military personnel. Am J Psychiatry. 2008;165:99–106.PubMedCrossRef
56.
Yolken RH, Torrey EF. Are some cases of psychosis caused by microbial agents? A review of the evidence. Mol Psychiatry. 2008;13:470–9.PubMedCrossRef
57.
Dantzer R, O’Connor JC, Freund GG, Johnson RW, Kelley KW. From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosci. 2008;9:46–56.PubMedPubMedCentralCrossRef
58.
59.
Kayser MS, Kohler CG, Dalmau J. Psychiatric manifestations of paraneoplastic disorders. Am J Psychiatry. 2010;167:1039–50.PubMedCrossRef
60.
Lennox BR, Coles AJ, Vincent A. Antibody-mediated encephalitis: a treatable cause of schizophrenia. Br J Psychiatry. 2012;200:92–4.PubMedCrossRef
61.
Rose NR. The role of infection in the pathogenesis of autoimmune disease. Semin Immunol. 1998;10:5–13.PubMedCrossRef
62.
Tsigos C, Chrousos GP. Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res. 2002;53:865–71.PubMedCrossRef
Metadata
Title
Psychiatric comorbidity in chronic urticaria patients: a systematic review and meta-analysis
Authors
Gerasimos N. Konstantinou
George N. Konstantinou
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Clinical and Translational Allergy / Issue 1/2019
Electronic ISSN: 2045-7022
DOI
https://doi.org/10.1186/s13601-019-0278-3

Other articles of this Issue 1/2019

Clinical and Translational Allergy 1/2019 Go to the issue

Research

Evaluation of major mite allergens from European standardized commercial extracts for in vivo diagnosis: addressing the need for precision medicine

Review

Subcutaneous immunotherapy with depigmented-polymerized allergen extracts: a systematic review and meta-analysis

Research Letter

Adherence to adrenaline autoinjector prescriptions in patients with anaphylaxis

Correction

Correction to: Dissociating polysensitization and multimorbidity in children and adults from a Polish general population cohort

Research

Characterization of a subgroup of non-type 2 asthma with cow’s milk hypersensitivity in young subjects

Letter to the Editor

An update to the Milk Allergy in Primary Care guideline