title: Psychosocial factors and chronic spontaneous urticaria: a systematic review.
abstract: BACKGROUND
  Chronic spontaneous urticaria (CSU) is one of the most costly allergic conditions challenging physicians as well as patients and their families. Despite evident lacunae in the understanding of the pathogenesis, at least some findings suggest that psychosocial factors likely contribute to the development and exacerbation of CSU. We aim to assess the contribution of psychological factors to CSU.
  
  
  METHODS
  Systematic search of PubMed and OVID/Medline databases was conducted from 1 January 1935 to 1 January 2012. Studies selected include original research in English, Spanish and French exploring the association between CSU and psychosocial factors. Two investigators independently reviewed all titles and abstracts to identify potentially relevant articles and resolved discrepancies by repeated review and discussion and arbitration of a third reviewer. Quality of systematic reviews and meta-analyses was assessed using a measure based on the Newcastle-Ottawa Scale and psychological conditions of CSU patients.
  
  
  RESULTS
  We identified 114 eligible studies spanning 77 years and featuring 17 reviews, 67 studies related to neither CSU nor psychosocial factors, and eight studies that provided either no prevalence estimates or insufficient sample size. Pooling effect sizes using random effects, analyses revealed that, despite large heterogeneity (I(2) of 97.60%), psychosocial factors had a prevalence of 46.09% (95% confidence interval, 44.01%, 48.08%).
  
  
  CONCLUSIONS
  Future research needs to better establish the contribution of psychosocial factors to the pathogenesis and exacerbation of CSU, and explore the possible benefit of behavioural interventions to the development of new management strategies.
authors.affiliation: Division of Paediatric Allergy and Clinical Immunology, Department of Paediatrics, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Ben-Shoshan
authors.forename: I
authors.initials: I
authors.lastname: Blinderman
authors.forename: A
authors.initials: A
authors.lastname: Raz
mesh_terms: D001521:Behavior Therapy; D016022:Case-Control Studies; D002908:Chronic Disease; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D020380:Needs Assessment; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D011584:Psychology; D011792:Quebec / Q000453:epidemiology; D012016:Reference Values; D012720:Severity of Illness Index; D014581:Urticaria / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy