Does urticaria risk increase in patients with celiac disease? A large population-based cohort study

Abstract

Background Case reports and smaller case-control studies suggest an association between celiac disease (CD) and urticaria, but risk estimates have varied considerably across studies and as yet there are no studies on CD and the risk of future urticaria. Objective To examine the association between CD and urticaria. Methods We identified 28,900 patients with biopsy-verified CD (equal to Marsh stage 3) and compared them with 143,397 age- and sex-matched controls with regards to the risk of urticaria and chronic urticaria (duration ≥6 weeks). Hazard ratios (HRs) were estimated using a Cox regression model. Results During follow-up, 453 patients with CD and no previous diagnosis of urticaria developed urticaria (expected n=300) and 79 of these 453 had chronic urticaria (expected n=41). The corresponding HRs were 1.51 for any urticaria (95%CI=1.36–1.68) and 1.92 for chronic urticaria (95%CI=1.48–2.48). The absolute risk for urticaria in CD was 140/100,000 person-years (excess risk=47/100,000 person-years). Corresponding figures for chronic urticaria were 24/100,00 person-years and 12/100,000 person-years. Patients with CD were also at increased risk of having both urticaria (odds ratio, OR=1.31; 95%CI=1.12–1.52) and chronic urticaria (OR=1.54; 95%CI=1.08–2.18) prior to the CD diagnosis. Conclusion This study suggests that CD is associated with urticaria, especially chronic urticaria.

Cutaneous and Mucosal Manifestations Associated with Celiac Disease

“…The corresponding hazard ratios were 1.51 for any urticaria (95%CI = 1.36–1.68) and 1.92 for chronic urticaria (95%CI = 1.48–2.48). These data support an increased prevalence of urticaria and chronic urticaria in patients with CD [ 12 ].…”

“…Recently, Kolkhir et al stated that chronic spontaneous urticaria is strongly linked with various autoimmune diseases, including Hashimoto’s thyroiditis, pernicious anemia, vitiligo, diabetes mellitus type 1, Grave’s disease, rheumatoid arthritis, and CD [ 40 ]. In a large population study, 453 patients with CD and no previous diagnosis of urticaria developed urticaria, and 79 of these 453 patients had chronic urticaria [ 12 ]. The corresponding hazard ratios were 1.51 for any urticaria (95%CI = 1.36–1.68) and 1.92 for chronic urticaria (95%CI = 1.48–2.48).…”

“…These data suggest a relationship among the immunological systems of the thyroid, skin, and small bowel, which seem to be more susceptible to developing aberrant immunological responses against auto-antigens. [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ].…”

“…In addition, there is growing evidence that supports the link between CD and several skin disorders. In 2006, Humbert et al proposed a classification of skin diseases associated with CD, dividing them into four categories: autoimmune, allergic, inflammatory, and miscellaneous ( Table 1 ) [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Recently, Bonciolini et al described 17 patients affected by non-celiac gluten sensitivity with skin manifestations similar to eczema, psoriasis, and DH who did not show a specific histological pattern [ 20 ].…”

Management of chronic urticaria in children: a clinical guideline

“…A remission of cutaneous symptoms after a gluten free diet has been also reported [2]. Conversely, studies on large populations highlighted a slightly higher prevalence of CU as well as AU in patients with coeliac disease in comparison to healthy controls [99, 111].…”