Abstract
BackgroundOne-quarter of systemic symptoms associated with chronic spontaneous urticaria (CSU) are related to gastrointestinal complaints (GICs).ObjectivesTo investigate the prevalence and features of urticaria-overlapping GICs.MethodsIn this retrospective cross-sectional survey, 1426 consecutive outpatients were observed at our University Department. Only patients suffering from urticaria or GICs with a complete diagnostic work-up including serum total IgE level (Tot-IgE), differential blood count and urticaria activity score (UAS), were evaluated.ResultsAmong different GICs, gastroesophageal reflux disease (GERD) was the most frequent syndrome observed (15.4%; 95%CI: 13.6–17.3). The prevalence of overlap syndrome for urticaria and GERD was 5.9% (95%CI: 4.7–7.2). In urticaria-patients, the prevalence of GERD was four-fold higher than in patients without hives (44% vs. 11%, p<0.001). UAS was significantly higher in urticaria and GERD overlap syndromes vs. isolated urticarias. In patients with GERD or acute/chronic urticaria or overlap syndrome, Tot-IgE and eosinophil blood count (EBC) differed significantly, with a stepwise increase in their values; from the subgroup of patients with GERD only, to that with overlap of CSU to GERD. Prevalence values for urticaria overlapping with GERD were three- and two-fold higher in CSU and in long-duration GERD cases respectively compared to acute urticaria or short-duration GERD cases. Similar to Th2 pathology models, CSU and GERD overlap syndrome was significantly and independently associated with Total-IgE ≥100IU/ml or EBC ≥250/mmc compared to CSU or GERD. Endoscopic/bioptic findings of non-erosive reflux disease (NERD) or Barrett’s esophagus (BE) were more frequent in chronic overlap syndrome than in GERD-patients.ConclusionsGERD was the most frequent GIC in patients with urticaria. Overlap syndrome was more frequent among patients with CSU, where this syndrome was associated with higher values of UAS, Tot-IgE, EBC and frequencies of NERD and BE. These results suggest that overlap syndrome is frequently a chronic syndrome with a Th2-like profile.
Highlights
Urticaria is a common and heterogeneous skin disorder characterised by a mast cell-driven vascular reaction causing wheals, itch and /or angioedema in response to several either identifiable infectious, allergic, physical, chemical and psychological stimuli or other unidentifiable stimuli [1,2,3,4,5,6] Due to known or unknown causes and excluding physical stimuli, when recurrence of symptoms persist for 6 or >6 weeks, this urticarial skin eruption is defined as acute spontaneous urticaria (ASU) or chronic spontaneous urticaria (CSU), respectively [1]
Overlap syndrome was more frequent among patients with CSU, where this syndrome was associated with higher values of urticaria activity score (UAS), total IgE level (Tot-IgE), eosinophil blood count (EBC) and frequencies of non-erosive reflux disease (NERD) and Barrett’s esophagus (BE)
These results suggest that overlap syndrome is frequently a chronic syndrome with a Th2-like profile
Summary
Urticaria is a common and heterogeneous skin disorder characterised by a mast cell-driven vascular reaction causing wheals, itch and /or angioedema in response to several either identifiable infectious, allergic, physical, chemical and psychological stimuli or other unidentifiable stimuli [1,2,3,4,5,6] Due to known or unknown causes and excluding physical stimuli, when recurrence of symptoms persist for 6 or >6 weeks, this urticarial skin eruption is defined as acute spontaneous urticaria (ASU) or chronic spontaneous urticaria (CSU), respectively [1]. The pathophysiology of CSU is not yet completely understood, a strong characteristic of the disease is the specific increased activation and/or degranulation of skin mast cells (MCs). These are primed to increase the release of proinflammatory and vasoactive mediators through different immunological or non-immunological stimuli and synergistic/sequential different pathomechanisms [6,7,8,9,10,11,12]. With regard to prevalence data from clinical studies, in a recent clinical survey involving patients affected with CSU, 64% of patients reported concomitant systemic complaints, consisting of gastrointestinal complaints (GICs) in more than a quarter of cases Gastrointestinal complaints in these patients were associated with greater disease burden and higher serum tryptase levels [27]. One-quarter of systemic symptoms associated with chronic spontaneous urticaria (CSU) are related to gastrointestinal complaints (GICs)
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