Objectives: Chronic urticaria (CU) and fibromyalgia (FM) are different types of diseases with unclear etiopathogeneses but share many clinical and histochemical features. This study aims to make a recognization on these features and examines whether patients with CU are also affected by FM. Patients and methods: Forty patients with CU and 38 healthy controls were enrolled to this study. All of the participants were assessed according to the 1990 American College of Rheumatology (ACR) classification criteria for FM and asked questions regarding the clinical features of FM. The quality of life was assessed by the Nottingham Health Profile (NHP), while the psychological status was evaluated using the Hospital Anxiety and Depression Scale (HADS). Results: The incidence of FM was higher among the patients with CU (32.5%) than the controls (10.5%) (p=0.019). We indicated that the patients with CU suffered restrictions regarding to quality of life as assessed by the NHP. NHP-sleep (p=0.035), NHP-social isolation (p=0.032) and NHP-emotional reaction (p=0.027) scores were significantly higher compared to HCs. The HADS-depression scores were also significantly higher in the patients with CU (p=0.006). The patients with CU and concomitant FM had higher total NHP scores than those without FM (p<0.001). Conclusion: Clinicians must be alerted to the possible coexistence of FM in CU patients. Patients with CU have higher rates of FM than the general population and this results in more restrictions in daily life in these patients than those with CU alone. Therefore, additional treatment protocols may be required to be implicated for the treatment of patients with both CU and FM.
1. Zuberbier T, Maurer M. Urticaria: current opinions about etiology, diagnosis and therapy. Acta Derm Venereol 2007;87:196205.
2. Hide M, Francis DM, Grattan CE, Hakimi J, Kochan JP, Greaves MW. Autoantibodies against the high- affinity IgE receptor as a cause of histamine release in chronic urticaria. N Engl J Med 1993;328:1599 604.
3. Niimi N, Francis DM, Kermani F, O'Donnell BF, Hide M, Kobza-Black A, et al. Dermal mast cell activation by autoantibodies against the high affinity IgE receptor in chronic urticaria. J Invest Dermatol 1996;106:10016.
4. Fiebiger E, Maurer D, Holub H, Reininger B, Hartmann G, Woisetschläger M, et al. Serum IgG autoantibodies directed against the alpha chain of Fc epsilon RI: a selective marker and pathogenetic factor for a distinct subset of chronic urticaria patients? J Clin Invest 1995;96:260612.
5. Tong LJ, Balakrishnan G, Kochan JP, Kinét JP, Kaplan AP. Assessment of autoimmunity in patients with chronic urticaria. J Allergy Clin Immunol 1997;99:4615.
6. Kikuchi Y, Kaplan AP. Mechanisms of autoimmune activation of basophils in chronic urticaria. J Allergy Clin Immunol 2001;107:105662.
7. Kaplan AP, Greaves M. Pathogenesis of chronic urticaria. Clin Exp Allergy 2009;39:77787.
8. Leznoff A, Sussman GL. Syndrome of idiopathic chronic urticaria and angioedema with thyroid autoimmunity: a study of 90 patients. J Allergy Clin Immunol 1989;84:6671.
9. Najib U, Sheikh J. The spectrum of chronic urticaria. Allergy Asthma Proc 2009;30:110.
10. Staubach P, Eckhardt-Henn A, Dechene M, Vonend A, Metz M, Magerl M, et al. Quality of life in patients with chronic urticaria is differentially impaired and determined by psychiatric comorbidity. Br J Dermatol 2006;154:2948.
11. O'Donnell BF, Lawlor F, Simpson J, Morgan M, Greaves MW. The impact of chronic urticaria on the quality of life. Br J Dermatol 1997;136:197201.
12. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990;33:16072.
13. Van Houdenhove B, Egle U, Luyten P. The role of life stress in fibromyalgia. Curr Rheumatol Rep 2005;7:36570.
14. Malhotra SK, Mehta V. Role of stressful life events in induction or exacerbation of psoriasis and chronic urticaria. Indian J Dermatol Venereol Leprol 2008;74:5949.
15. Blanco I, Béritze N, Argüelles M, Cárcaba V, Fernández F, Janciauskiene S, et al. Abnormal overexpression of mastocytes in skin biopsies of fibromyalgia patients. Clin Rheumatol 2010;29:140312.
16. Elias J, Boss E, Kaplan AP. Studies of the cellular infiltrate of chronic idiopathic urticaria: prominence of T-lymphocytes, monocytes, and mast cells. J Allergy Clin Immunol 1986;78:9148.
17. Nettis E, Dambra P, Loria MP, Cenci L, Vena GA, Ferrannini A, et al. Mast-cell phenotype in urticaria. Allergy 2001;56:915.
18. Salemi S, Rethage J, Wollina U, Michel BA, Gay RE, Gay S, et al. Detection of interleukin 1beta (IL-1beta), IL-6, and tumor necrosis factor-alpha in skin of patients with fibromyalgia. J Rheumatol 2003;30:14650.
19. Hermes B, Prochazka AK, Haas N, Jurgovsky K, Sticherling M, Henz BM. Upregulation of TNF-alpha and IL-3 expression in lesional and uninvolved skin in different types of urticaria. J Allergy Clin Immunol 1999;103:30714.
20. Staud R. Autonomic dysfunction in fibromyalgia syndrome: postural orthostatic tachycardia. Curr Rheumatol Rep 2008;10:4636.
21. Furlan R, Colombo S, Perego F, Atzeni F, Diana A, Barbic F, et al. Abnormalities of cardiovascular neural control and reduced orthostatic tolerance in patients with primary fibromyalgia. J Rheumatol 2005;32:178793.
22. Check JH, Gentlesk MJ, Falanga V. Sympathomimetic amines in the treatment of chronic urticaria: two case reports. Cutis 1984;34:38890.
23. Check JH, Katsoff D, Kaplan H, Liss J, Boimel P. A disorder of sympathomimetic amines leading to increased vascular permeability may be the etiologic factor in various treatment refractory health problems in women. Med Hypotheses 2008;70:6717.
24. Burckhardt CS, Clark SR, Bennett RM. The fibromyalgia impact questionnaire: development and validation. J Rheumatol 1991;18:72833.
25. Sarmer S, Ergin S, Yavuzer G. The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire. Rheumatol Int 2000;20:912.
26. Hunt SM, McKenna SP, McEwen J, Williams J, Papp E. The Nottingham Health Profile: subjective health status and medical consultations. Soc Sci Med A 1981;15:2219.
27. Kücükdeveci AA, McKenna SP, Kutlay S, Gürsel Y, Whalley D, Arasil T. The development and psychometric assessment of the Turkish version of the Nottingham Health Profile. Int J Rehabil Res 2000;23:318.
28. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:36170.
29. Aydemir O, Guvenir T, Kuey L, Kultur S. Validity and reliability of Turkish version of hospital anxiety and depression scale. Turk Psikiyatri Derg 1997;8:2807.
30. Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 1995;38:1928.
31. Topbas M, Cakirbay H, Gulec H, Akgol E, Ak I, Can G. The prevalence of fibromyalgia in women aged 20-64 in Turkey. Scand J Rheumatol 2005;34:1404.
32. Torresani C, Bellafiore S, De Panfilis G. Chronic urticaria is usually associated with fibromyalgia syndrome. Acta Derm Venereol 2009;89:38992.
33. Clauw DJ. The pathogenesis of chronic pain and fatigue syndromes, with special reference to fibromyalgia. Med Hypotheses 1995;44:36978.
34. Hashiro M, Okumura M. Anxiety, depression, psychosomatic symptoms and autonomic nervous function in patients with chronic urticaria. J Dermatol Sci 1994;8:12935.
35. Engin B, Uguz F, Yilmaz E, Ozdemir M, Mevlitoglu I. The levels of depression, anxiety and quality of life in patients with chronic idiopathic urticaria. J Eur Acad Dermatol Venereol 2008;22:3640.
36. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 2010;62:60010.
37. Staud R. Fibromyalgia pain: do we know the source? Curr Opin Rheumatol 2004;16:15763.