Stress Coping, Eosinophils, and Gender Differences in Adolescent Chronic Urticaria

Beyond immunological and allergic mechanisms, stress and psychological factors are increasingly recognized as contributors to chronic urticaria (CU) onset, persistence, and severity, particularly in adolescence.¹ Building on a biopsychosocial framework, a new study investigated the relationship between stress coping strategies, biological markers—particularly eosinophils—and disease activity and control in adolescents with CU, compared with healthy peers.²

Study Design and Methodology

This cross-sectional study was conducted in the Pediatric Allergy and Immunology Department of Basaksehir Cam and Sakura City Hospital, University of Health Sciences, in İstanbul, Turkey. It included 65 adolescents aged 12 to 18 years diagnosed with CU and 65 age- and sex-matched healthy controls. In CU patients, the mean age of diagnosis was 13.631 years. All participants completed the Turkish-adapted Coping Strategies Scale (SCS), which evaluates multiple dimensions of stress coping, including active struggle, resilience, optimism, personal control, social support seeking, and engagement with the environment.

In the CU group, clinical and laboratory data were collected, including complete blood count parameters, inflammatory markers, and immunological tests. Disease activity and control were assessed using validated tools: the Urticaria Activity Score over 7 days (UAS7) and the Urticaria Control Test (UCT). Statistical analyses included group comparisons, correlation analyses, and stepwise regression models to identify predictors of disease control.

Stress Coping and Disease Control

Overall, adolescents with CU did not differ significantly from healthy controls in total stress coping ability or in any SCS subscales. This finding suggests that, at a group level, adolescents with CU may develop coping strategies comparable to their healthy peers, possibly reflecting psychological adaptation to chronic illness. However, important gender-specific differences emerged. Male adolescents with CU demonstrated significantly higher total coping scores and higher scores in several subdomains—including struggle, resilience, optimism, and personal control—compared with healthy male controls. In contrast, no differences in coping strategies were observed between female patients and healthy females.

Within the CU cohort, males and females showed similar disease activity, but males had significantly better disease control as measured by UCT scores. Regression analysis identified female gender and higher eosinophil counts as independent predictors of poorer urticaria control, thus explaining a meaningful proportion of variance in UCT scores.

Eosinophils and Immunological Markers

Biological analyses revealed additional insights. Eosinophil counts and percentages were negatively correlated with symptom duration, suggesting dynamic changes in inflammatory profiles over the course of disease. Eosinophil levels were also associated with total IgE and basophil counts, consistent with known immunological relationships in CU. Notably, higher eosinophil percentages were negatively correlated with key coping dimensions, including struggle, realistic goal setting, and resilience. This association supports the hypothesis that immune activity and stress coping processes are interconnected, potentially through neuroimmunological pathways involving stress-related mediators and mast cell activation.

Contrary to some adult studies, eosinophil levels were not directly associated with disease activity (UAS7) in this adolescent cohort, underscoring possible age-related differences in CU pathophysiology. The finding that higher eosinophil counts were linked to poorer disease control, rather than activity, suggests that inflammatory markers may be more reflective of chronic disease regulation and psychosocial burden than of short-term symptom intensity.

Clinical Implications

According to the authors, these results emphasize the importance of adopting a biopsychosocial clinical approach in managing adolescents with CU. While standard antihistamine-based treatments address the biological aspects of disease, integrating stress management and psychological support may be particularly beneficial, especially for female patients who demonstrate poorer disease control without corresponding strengths in coping strategies. The observed associations between eosinophils and coping dimensions further suggest that psychosocial interventions could have downstream effects on immune regulation and disease outcomes.

References

1. Kemeny ME, Schedlowski M. Understanding the interaction between psychosocial stress and immune-related diseases: a stepwise progression. Brain Behav Immun. 2007;21(8):1009-1018. doi:10.1016/j.bbi.2007.07.010

2. Sarikavak T, Kaplan Sarikavak S, Çakmak E, Celiksoy MH. Biopsychosocial Insights on Adolescents With Chronic Urticaria: The Role of Eosinophils and Stress Coping Strategies. Clin Transl Allergy. 2025;15(12):e70127. doi:10.1002/clt2.70127