A reappraisal of the role of ‘mindbody’ factors in chronic urticaria

Abstract

Chronic spontaneous urticaria (CSU) is a very common skin condition that causes considerable suffering and is often poorly responsive to drug treatment regimens. Most clinicians accept that multiple factors play a role in the aetiology of CSU, but there is a widespread reluctance to accept a significant role for 'mindbody' factors, despite a large number of clinical reports and studies over many decades suggesting their relevance. This reluctance has multiple origins. A primary influence is the flawed dualistic model of mind and body relatedness underpinning much of modern medical care. In this view, if a pathophysiological mechanism can be discerned, then 'mind' factors can be largely ignored. Recent evidence demonstrating intimate structural and functional relations between peripheral nerves and mast cells, and local skin secretion of mast cell-influencing neuropeptides by nerves, provides an argument for discarding old 'organic' and dualistic conceptualisations of CSU. A sound, integrative, multifactorial approach requires a unitive 'mindbody' model in which physical and subjective dimensions of personhood are seen as coexisting and equally deserving of exploration and management. Another influence is the tendency for 'psychosomatic' research studies in CSU to focus on patient experience using broad group-based diagnostic categories, such as anxiety and depressive disorders, and generic measures of stress. Two case examples are given, illustrating that CSU arises in relation to highly individual and relevant 'stories', which would not usually be picked up by these generic measures. It is suggested that an appropriate 'mindbody' management programme leading to good clinical outcomes for CSU is dependent on clinicians discerning unique patient 'stories'. Finally, a lack of formal studies comparing drug and 'mindbody' treatment outcomes will continue to negatively influence the adoption of 'mindbody' approaches in CSU. There is an urgent need for properly structured comparative studies, and the essential elements of a suitable 'mindbody' approach appropriate to such research are briefly outlined.

Patient‐reported outcomes (PROs) in chronic urticaria

“…Further, the biomedical approach is dualistic and views emotional factors and physical manifestations of disease as separate entities. The standard approach to CSU treatment is no different even though literature suggests an important role of stress and emotional factors in CSU …”

“…The standard approach to CSU treatment is no different even though literature suggests an important role of stress and emotional factors in CSU. [36][37][38][39] A pilot study 40 Knowledge regarding the prevalence and etiology and disease management and therapy response in CSU among children and adolescents is scarce. 41 Gathering information regarding prevalence might best be done with school-based programs, as most CSU cases in childhood never reach specialists but are managed by general practitioners and from home.…”

Questions and answers in chronic urticaria: where do we stand and where do we go?

“…Assessing a patient's urticaria purely from the perspective of their clinical symptoms ignores a large and important part of their disease experience. Over the past century, a succession of reports has suggested a role for emotions and stress in initiating and perpetuating urticaria . Recent psychoneuro‐immunology research points to a significant influence of the ‘mind‐brain complex’ on the immune system.…”

A Study of Psychiatric Disorders and Chronic Urticaria

“…[20,16] This local lesion may be affected by nervous system as there is an organic and functional relation between mast cells and peripheral nervous system. [21] CONCLUSION Findings of the current study conclude that psychological disorders are found as co morbidity in chronic urticaria patients. Therefore, Psychiatrist assistance is unavoidable for the patients suffering with chronic urticaria to avoid as well as treatment of psychological disorders.…”