Psychological Stress and Chronic Urticaria: A Neuro-immuno-cutaneous Crosstalk. A Systematic Review of the Existing Evidence
Abstract
Purpose It has been observed that certain patients with chronic spontaneous or idiopathic urticaria (CSU/CIU) have a personal history of a significant stressor before urticaria onset, while the prevalence of any psychopathology among these patients is significantly higher than in healthy individuals. Research has confirmed that skin is both an immediate stress perceiver and a target of stress responses. These complex interactions between stress, skin, and the nervous system may contribute to the onset of chronic urticaria. This systematic review investigated the association between CSU/CIU and neuroimmune inflammation with or without evidence of co-existing psychological stress from in vivo and ex vivo studies in human beings.Methods PubMed and Scopus were searched to September 2019 for reports in human beings describing neuroimmune inflammation, stress, and CSU/CIU. A comprehensive search strategy was used that included all the relevant synonyms for the central concept.Findings A total of 674 potentially relevant articles were identified. Only 13 satisfied the predefined inclusion criteria and were included in the systematic review. Five of these 13 studies evaluated the correlation between CSU/CIU, stress, and neuro-immune-cutaneous factors, while the remaining 8 focused on the association between CSU/CIU and these factors without examining any evidence of stress.Implications The complex neuro-immune-cutaneous model that involves numerous neuropeptides and neurokinins, inflammatory mediators and cells, hypothalamic-pituitary-adrenal axis hormones, and the skin may better explain the underlying pathophysiological mechanisms involved in the onset of urticaria. In addition, the elevated psychological stress level that has been closely related to CSU/CIU could be attributed to the imbalance or irregularity of this neuro-immune-cutaneous circuit. It is still unclear and must be further investigated whether any psychological stress results in or triggers CSU/CIU onset on top of a preexisting neuroimmune dysregulation. Nevertheless, new psycho-phenotypic or neuro-endotypic CSU/CIU subsets should be considered as the era of personalized treatment strategies emerges. A better understanding of CSU/CIU pathophysiology and consideration of the patient as a whole is vital for identifying targets for new potential treatment options.
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Could distress tolerance levels be associated with the severity of chronic spontaneous urticaria?
Göçer Gürok, N., Gürok, M. G., & Öztürk, S. (2022) · TURKDERM · doi:10.4274/turkderm.galenos.2022.46793
- Authors
- Konstantinou, G. N., & Konstantinou, G. N.
- Affiliations
- University of Toronto (CA)
- Venue
- Clinical Therapeutics
- Publisher
- Elsevier BV
- Published
- 2020-05
- Volume
- 42
- Issue
- 5
- Pages
- 771-782
- ISSN
- 0149-2918 (ISSN-L)
- OpenAlex
- W3022820044
- Cited by
- 58
- References
- 80
- Citations by year
- 2026: 13 · 2025: 9 · 2024: 10 · 2023: 8 · 2022: 8 · 2021: 7 · 2020: 3
- FWCI
- 1.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Urticaria and Related Conditions
- Life Sciences › Immunology and Microbiology › Immunology › Mast cells and histamine
- Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
- Keywords
- chronic spontaneous urticaria, psychological stress, hypothalamic-pituitary-adrenal axis, neuropeptides, neurokinins, urticaria pathophysiology, psychopathology, personalized treatment
- MeSH terms
- Chronic Urticaria, Brain, Humans, Skin, Stress, Psychological
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