URTICARIA ASSOCIATED WITH SYSTEMIC DISEASE AND PSYCHOLOGICAL FACTORS

Abstract

Chronic idiopathic urticaria, diagnosed by excluding the most frequent causes of acute recurrent urticaria, such as IgE-mediated disease and drug exposure (nonsteroidal anti-inflammatory drugs [NSAIDs] and opiates), may be caused by an underlying systemic illness. In this article, we examine various diseases that have been implicated as causative factors in chronic urticaria. The most common pathologic finding in idiopathic urticaria appears to be a histamine-releasing autoantibody that binds the IgE receptor present on mast cells and basophils. Rarely, other autoimmune illnesses such as systemic lupus erythematosus or immune complex disease may be implicated as causative factors, particularly when biopsy specimens of the urticarial lesion reveal a vasculitic histopathology. Although less well documented, several types of infection and malignancy are discussed that have occasionally been associated with chronic urticaria. Also, several unusual hereditary syndromes in which urticaria is a commonly observed feature are described. Finally, the possible contributions of psychological factors to the morbidity of chronic urticaria are presented to call attention to the high incidence of depressive symptoms and anxiety among persons who suffer from this often debilitating disease.