Abstract
PurposeAutoimmunity has been implicated in some patients with idiopathic chronic urticaria (CU). Because of the frequency of autoimmune thyroid diseases, their association with CU deserves special attention. We tested both the existence and the extent of an association between thyroid autoimmunity and CU.MethodsA thorough search of PubMed, Scopus, Web of Science, and Cochrane databases was performed. Studies reporting the positivity rate for anti-thyroperoxidase antibodies (TPOAbs) in people with (cases) and without CU (controls) were included. Quality of the studies was assessed by the Newcastle–Ottawa Scale. Between-study heterogeneity was assessed by Cochrane Q and I2 tests, and the odds ratio (OR) for TPOAbs positivity was combined using random-effects models.ResultsNineteen studies provided information about TPOAbs positivity on 14,351 patients with CU and 12,404 controls. The pooled estimate indicated a more than fivefold increased risk of exhibiting TPOAbs positivity in the group with CU (pooled OR 5.18, 95% CI 3.27, 8.22; P < 0.00001). Correction for publication bias had a negligible effect on the overall estimate (pooled adjusted OR: 4.42, 95% CI 2.84, 6.87, P < 0.0001). Between‑study heterogeneity was established (I2 = 62%, Pfor heterogeneity = 0.0002) and when, according to meta‑regression models, a sensitivity analysis was restricted to the 16 studies with the highest quality scores, the OR for TPOAbs positivity rose to 6.72 (95% CI 4.56, 9.89; P < 0.00001) with no significant heterogeneity (I2 = 31%, Pfor heterogeneity = 0.11).ConclusionsPatients with CU have a five-to-nearly sevenfold higher risk of displaying TPOAbs positivity. All patients with CU may well be offered a screening for thyroid autoimmunity.
Highlights
The term “urticaria” is widely used to define a skin manifestation characterized by the onset of itchy, fleeting wheals of variable size, shape, and distribution
The meta-analysis was conducted according to the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [30]; it complies with the guidelines for Meta-Analyses and Systematic Reviews of Observational Studies (MOOSE) [31]
The 19 studies included in the meta-analysis provided information on 14,351 patients with chronic urticaria (CU) and 12,404 subjects without CU, resulting in an overall crude rate of thyroperoxidase antibodies (TPOAbs) positivity of 3.8%
Summary
The term “urticaria” is widely used to define a skin manifestation characterized by the onset of itchy, fleeting wheals of variable size, shape, and distribution. These features arise from a series of pathophysiological events, including. Andrology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy. Epidemiology Division, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy. In about 75% of patients, causes remain undefined, configuring the idiopathic CU [3]; many different pathogenic mechanisms have been proposed, including the occurrence of autoimmunity. In some patients, CU may be associated with autoimmune diseases (AID) or, more generally, with positivity for autoantibodies [4, 5]. That between CU and thyroid autoimmunity has attracted interest, especially because of the epidemiological dimension of the autoimmune thyroid diseases
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