Effect of arterial hypertension on chronic urticaria duration.
BACKGROUND
Reliable clinical or laboratory markers of chronic idiopathic urticaria (CIU) duration are not available. Angioedema, autologous serum skin test (ASST) results, and antithyroid antibodies have been inconsistently associated with longer urticaria duration.


OBJECTIVE
To investigate the association of clinical and laboratory parameters with CIU duration, including systemic hypertension, because activation of the coagulation cascade pathway may contribute to the pathogenesis of CIU.


METHODS
We performed a prospective study of a cohort of 228 consecutive adult patients with CIU of moderate to severe intensity referred to 2 outpatient allergy clinics and followed up for a 3- to 5-year period. The association of clinical and laboratory parameters (sex, atopy, markers of autoimmunity, antithyroid antibodies, positive ASST result, Helicobacter pylori infection, and hypertension) with urticaria duration was analyzed using semiparametric multivariable proportional hazards models (Cox regression) using remission as main outcome measure.


RESULTS
Apart from systemic hypertension (hazard ratio, 0.71; 95% confidence interval, 0.53-0.95; P = .02), none of the considered parameters influenced CIU remission of our patients; 74% and 54% of our patients with and without hypertension, respectively, still had CIU after 5 years.


CONCLUSIONS
Our results show, for the first time to our knowledge, that hypertension is associated with extended duration of CIU. This observation, together with the previous findings that point to vascular and coagulation involvement in CIU, may suggest a new approach to antihistamine-refractory CIU treatment, including adequate treatment of hypertension.
Nebiolo
Franco
F
Allergy and Clinical Immunology, University of Torino and AO Ordine Mauriziano Hospital, Torino, Italy.
Bergia
Roberta
R
Bommarito
Luisa
L
Bugiani
Massimiliano
M
Heffler
Enrico
E
Carosso
Aurelia
A
Castiglioni
Gloria
G
Guida
Giuseppe
G
Badiu
Iuliana
I
Pizzimenti
Stefano
S
Mietta
Sabrina
S
Ferrero
Nicoletta
N
Rolla
Giovanni
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D014581:Urticaria / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*
D006633:Histamine Antagonists