Urticaria is a transient erythematous swelling of the skin, associated with itching, which usually resolves within 24 hours.  It is caused by degranulation of histamine containing cells (mast cells) in the superficial dermis.[1]

CSU is diagnosed when urticaria is present for more than 6 weeks and when it has been determined that an apparent protracted episode of urticaria is not the result of recurrent episodes of acute urticaria.  There typically is no identifiable food or medication causing it and the incidence of finding a food allergen as cause when urticaria persists for over six weeks, skin testing or RAST testing for food allergy is not recommended.  The lesions can vary greatly in shape or size but are roughly circular.  They feel somewhat indurated (not flat) and individual lesions last 12-24 hrs.  This latter characteristic also distinguishes it from inducible urticarias except for delayed pressure urticaria.[1-4]

Most of the Patients with chronic spontaneous urticaria report systemic complaints. Headache, dizziness, hoarseness, wheezing, sensation of a lump in the throat, shortness of breath, nausea, vomiting and an abdominal pain, diarrhoea and arthralgias may occur as concomitant systemic manifestations of severe episodes of urticaria.[1-6]

There is scarce information on the frequency and characteristics of associated systemic symptoms amongpatients with Chronic Spontaneous Urticariain Himachal Pradesh. Therefore present study was done to evaluate the frequency and characteristics of associated systemic symptoms amongpatients with Chronic Spontaneous Urticaria.

Aims and Objectives

To evaluate the frequency and characteristics of associated systemic symptoms amongpatients with Chronic Spontaneous Urticaria

• Research Approach -Descriptive

• Research Design- Hospital based  Cross-sectional survey design

• Study area: OPD of Dermatology, Venereology & Leprosy clinic of Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh

• Study duration- between April 2016 and March 2017

• Study population-  Patients of Chronic Spontaneous Urticaria

• Sample size- All 100 consecutive patients of chronic Spontaneous urticaria aged 18 years and above attending the outpatient Dermatology, Venereology & Leprosy clinic of Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh between April 2016 and March 2017 were enrolled for the study.

• Inclusive Criteria- who were willing to participate in the study.

• Exclusion Criteria:

1. Patients suffering from physical urticaria, urticarial vasculitis, or acute urticaria.

2. Patients younger than 18 years of age.

3. Pregnant and lactating women.

4. Patients taking medications that can influence the coagulation/fibrinolysis pathway (asprin, clopidogrel, warfarin, heparin).

• Study tool: A self designed, close ended questionnaires consisting of socio-demography, 

• symptoms, duration, previous medical history etc. was created. 

• Validity of tool - by the experts in this field

• Data collection- Data was collected under the guidance of supervisors. The demographic profile, age, sex, occupation, place of residence, duration and evolution of urticaria, personal and family history, detailed medical history and clinical details of urticaria were recorded on a pre-designed proforma. Physical urticaria was excluded on the basis of thorough clinical history/examination and provocation tests. A clinical examination and investigations were performed to exclude systemic diseases/infections known to cause urticaria. 

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage, mean standard deviation etc..

• Ethical Considerations- The study was conducted after approval from Institutional Protocol Review Board and Institutional Ethics Committee. The patients were enrolled only after informed consent and after clarifying their queries regarding the study. Participant’s confidentiality and anonymity was maintained.

The study comprised 100 consecutive patients with chronic Spontaneous urticaria and had 25 males and 75 females (M:F=1:3) aged between 18 and 69 (mean±SD = 36.12±10.88) years. Thirty seven (37%) patients  were aged less than or equal to 30 years and 9 patients were more than 50 years of age. The majority, 68(68%) patients were aged between 18-40 years followed by 23(23%) patients in the age group of 41-50 years. 

Among the total patients, maximum 32 patients had feeling of hot or cold, 23 patients experienced general symptoms like Headache, Loss of concentration, Malaise, Lassitude, Feverish feel. Similarly, flushing was experienced by 20 patients .Gastrointestinal symptoms like Nausea,Vomiting, Diarrhea, indigestion & pain abdomen as well as  joint symptoms such as joint pains and swelling was seen in 18 patients each.  On the other hand, cardio-respiratory symptoms like Syncope, Palpitations Breathlessness /wheeze was seen in 11 patients (Table-2).

Table -2: Individual Associated Systemic Symptoms

Among the total patients , 34 patients experienced 1 associated systemic symptoms,25 patients  experienced 2 associated systemic symptoms,  17 patients experienced 3 associated systemic symptoms, 6 patients experienced 4 associated systemic symptoms , 1 patient experienced 5 associated systemic symptoms while 17 patients experienced no associated systemic symptoms. (Table-3). 

Table 3: No. Of Experienced Associated Systemic Symptoms

Most of the Patients with chronic spontaneous urticaria report systemic complaints.  Therefore present study was done to evaluate the frequency and characteristics of associated systemic symptoms amongpatients with Chronic Spontaneous Urticaria.[6]

The present study comprised 100 consecutive patients with chronic Spontaneous urticaria and had 25 males and 75 females (M:F=1:3) aged between 18 and 69 (mean±SD = 36.12±10.88) years. Similar to our study, in the study done [7]  chronic urticaria-angioedema occurred mainly in females (mean age: 35 years), but also in men (mean age: 32 years).

In the present study, among the total patients, maximum 32 patients Feeling of hot or cold, 23 patients experienced general symptoms like Headache, Loss of concentration, Malaise, Lassitude, Feverish feel. Similarly, flushing was experienced by 20 patients .Gastrointestinal symptoms like Nausea, Vomiting, Diarrhea, indigestion & pain abdomen as well as  joint symptoms such as joint pains and swelling was seen in 18 patients each. On the other hand, cardio-respiratory symptoms like Syncope, Palpitations Breathlessness /wheeze was seen in 11 patients. In our study, among the total patients , 34 patients experienced 1 associated systemic symptoms,25 patients  experienced 2 associated systemic symptoms,  17 patients experienced 3 associated systemic symptoms, 6 patients experienced 4 associated systemic symptoms , 1 patient experienced 5 associated systemic symptoms while 17 patients experienced no associated systemic symptoms. Similar to our study, [8] were surveyed 155 patients with CIU, with 103 reporting SCs with concomitant hives as follows: joint pain or swelling (55.3%), headache/fatigue (47.6%), flushing (42.7%), wheezing (30.1%), gastrointestinal complaints (26.2%), and palpitations (9.7%). 

The present study concluded that most of the patients of Chronic Spontaneous Urticaria experienced one or more associated systemic symptoms and Feeling of hot or cold, Headache, Loss of concentration, Malaise, Lassitude & Feverish feel were the most common experienced associated systemic symptoms.

Limitations

Small number of patients, lack of treatment outcome measures, and unavailability of specific parameters to determine coagulation pathway activation, and a cross-sectional nature of study are some of the limitations of this study.

The authors declare that they have no conflict of interest

No funding sources

The study was approved by the Civil hospital, Rampur, District Shimla, Himachal Pradesh, India.

1. World allergy. Available at: https://www.worldallergy.org/education-and-programs/education/allergic-disease-resource-center/professionals/urticaria (Accessed on 05 December 2021)

2. Magen E, Mishal J. Possible benefit from treatment of Helicobacter pylori in antihistamine‐resistant chronic urticaria. Clinical and Experimental Dermatology: Clinical dermatology. 2013 Jan;38(1):7-12.

3. Sachdeva S, Gupta V, Amin SS, Tahseen M. Chronic urticaria. Indian Journal of Dermatology. 2011 Nov;56(6):622.

4. Shankar DK, Ramnane M, Rajouria EA. Etiological approach to chronic urticaria. Indian Journal of Dermatology. 2010 Jan;55(1):33.

5. Yadav S, Upadhyay A, Bajaj AK. Chronic urticaria: An overview. Indian Journal of Dermatology. 2006 Jul 1;51(3):171.

6. Deacock SJ. An approach to the patient with urticaria. Clin Exp Immunol 2008;153:151-61.

7. Silvares MR, Coelho KI, Dalben I, Lastória JC, Abbade LP. Sociodemographic and clinical characteristics, causal factors and evolution of a group of patients with chronic urticaria-angioedema. Sao Paulo Medical Journal. 2007;125:281-5.

8. Doong JC, Chichester K, Oliver ET, Schwartz LB, Saini SS. Chronic idiopathic urticaria: systemic complaints and their relationship with disease and immune measures. The Journal of Allergy and Clinical Immunology: In Practice. 2017 Sep 1;5(5):1314-8.