Chronic Urticaria Is Linked to Increased Odds of Psychiatric Comorbidity

Urticaria | Image Credit: © DermNet

Chronic urticaria (CU) is linked to increased odds of developing psychiatric comorbidities, according to results of a recent study published in the Journal of the European Academy of Dermatology and Venereology.¹

Researchers reported that individuals with CU have increased odds of developing attention-deficit/hyperactivity disorder, anxiety, depression, posttraumatic stress disorder, and other conditions, with the highest risk for psychological stress and dysthymia.¹

Background and Methods

It has already been well-established that CU is associated with a number of comorbidities. A 2022 Frontiers in Allergy study detailed links not only to psychiatric comorbidities but to various malignancies, cardiovascular diseases, autoimmune disorders, atopic disorders, and more.²

With established negative impacts on quality of life, previous reports have also identified higher rates of anxiety and depression, as well as greater pooled prevalence of mental health- associated disorders, among individuals with CU than those without.³

Adjei-Frimpong and colleagues conducted a case-controlled study involving adults with CU in the US who had been a part of the All of US research program, pulling information from the database collected from May 6, 2018, to February 26, 2025.¹

Findings

The study analyzed data from 1171 individuals with CU and 4684 matched controls.¹

The prevalence of psychiatric conditions was consistently higher in the CU group than in controls. After adjusting for autoimmune comorbidities, multivariable models revealed significantly elevated ORs for several psychiatric diagnoses.

Patients with CU were more than 3 times more likely to have anxiety (OR, 3.48), depression (OR, 3.26), or insomnia (OR, 3.27). Furthermore, the odds of developing dysthymia were especially elevated (OR, 3.67).

Additional psychiatric comorbidities showed similarly high associations. The odds of having attention-deficit/hyperactivity disorder were markedly increased among patients with CU (OR, 3.61), as were those of posttraumatic stress disorder (OR, 3.25), psychological stress (OR, 3.92), and substance use disorder (OR, 2.13).

Conclusions

These findings collectively point to a significant mental health burden carried by individuals with CU, which may reflect both shared pathophysiologic mechanisms and the psychosocial impact of having CU.

Limitations of the study may have included an absence of data on length of time until diagnosis, severity of CU at onset, and more, the study authors noted.

"Clinicians should pursue a comprehensive evaluation when caring for CU patients," the study authors wrote. "Routine screenings for psychiatric disorders should be incorporated into CU patient care to ensure prompt intervention and/or referral. Prospective studies analyzing additional psychiatric disorders and underlying mechanisms characterizing this link will help further clarify meaningful associations that can be used to inform appropriate psychiatric screenings and management."¹

References

1. Adjei-Frimpong NA, Cortes J, Fakhouri SK, Delacqua F, Oldenburg R. Association of psychiatric comorbidities with chronic urticaria: a nested case-control study in the All of Us research program. J Eur Acad Dermatol Venerol. Published online May 14, 2025. doi:10.1002/jvc2.70063
2. Papapostolou N, Xepapadaki P, Katoulis A, Makris M. Comorbidities of chronic urticaria: a glimpse into a complex relationship. Front Allergy. 2022;3:1008145. doi:10.3389/falgy.2022.1008145
3. Ghazanfar MN, Sørensen JA, Zhang D, Holgersen NK, Vestergaard C, Thomsen SF. Occurrence and risk factors of mental disorders in patients with chronic urticaria. World Allergy Organ J. 2023;16(11):100835. doi:10.1016/j.waojou.2023.100835