Chronic urticaria: association with thyroid autoimmunity

Abstract

Background: Though autoimmune phenomena have been regularly associated with chronic urticaria in adults, data in children are sparse. Aim: To describe our experience with children and adolescents with chronic urticaria and autoimmunity. Methods and Results: Of 187 patients referred for evaluation of chronic urticaria during a 7.5 year period, eight (4.3%), all females aged 7-17 years, had increased levels of antithyroid antibody, either antithyroid peroxidase antibody (n = 4, >75 IU/ml), antithyroglobulin antibody (n = 2, >150 IU/ml), or both (n = 2). The duration of urticaria was four months to seven years. Five patients were euthyroid, one of whom was found to have increased antithyroid antibody levels five years after onset of the urticaria. One patient was diagnosed with Hashimoto thyroiditis three years before the urticaria, and was receiving treatment with thyroxine. Two other hypothyroid patients were diagnosed during the initial work up for urticaria (thyroxine 9.2 pmol/l, thyroid stimulating hormone (TSH) 40.2 mIU/l) and five years after onset of the urticaria (thyroxine 14 pmol/l, TSH 10.3 mIU/l). Both were treated with thyroxine but neither had remission of the urticaria. Five patients had a low positive titre of antinuclear antibodies. Conclusion: Children with chronic urticaria should be screened periodically for thyroxine, TSH, and antithyroid antibodies, as thyroid autoimmunity and hypothyroidism may appear several years after onset of the urticaria.

BSACI guideline for the management of chronic urticaria and angioedema

“…An association between childhood chronic urticaria and thyroid autoimmunity has been postulated [101,104]. It is not clear whether the association is causal, as the majority of children present with hyper-or hypothyroid symptoms either before or some time after the onset of chronic urticaria.…”

“…31-47% of children with CU have an autoimmune aetiology with a positive ASST [18,19]. About 4% of children with CU have positive antithyroid antibodies, the majority of these are euthyroid [101] (Table 2).…”

“…The urticarial symptoms do not always improve with thyroxine replacement therapy. Nonetheless, ongoing thyroid function monitoring is encouraged for children with CU and thyroid autoimmunity [18,101].…”

Evaluation the Effects of Levothy Roxine on Patients with Chronic Pruritus and Anti-TPO+

“…It shall be mentioned that some studies have not had satisfactory results. For example, in the research by Levy et al no improvement was observed in patients (17). Moreover, in the study by Feibelmann et al no relationship was found (18).…”

Chronic Urticaria in Children: An Update about Etiology

“…Chronic urticaria was observed in 7% to 8% children with autoimmune thyroiditis [13]. In another study, 4.3% of children with chronic urticaria had positive anti-thyroid antibody [14]. If symptoms other than urticaria present, further evaluation must be done.…”