Chronic urticaria: inflammation and depression are linked with worse itch

Published online May 28, 2025

Chronic spontaneous urticaria (CSU) is a dermatological disease that severely affects patients’ lives by burdening them with recurrent skin lesions (hives), which are accompanied by an often intense and debilitating itch. The unpredictable occurrence and difficult treatment of itch sparked the interest of Stolz and colleagues to find possible factors contributing to higher itch severity in patients with CSU. They also aimed to investigate whether the itch severity is linked to impaired quality of life and an increased utilization of health care resources.

Their analysis – the results of which were published in The Journal of Allergy and Clinical Immunology: In Practice – included data of 3,045 CSU-patients from the Chronic Urticaria registry (CURE). In CURE, real-world data is collected in several urticaria centers worldwide, using questionnaires filled out by patients and their physicians. The questionnaires inquired about symptoms, comorbidities, laboratory findings, quality of life, and health care utilization. Patients also reported the severity of their itch in the week prior to enrollment (no, mild, moderate, intense itch).

The authors showed that signs of systemic inflammation like recurrent fever, malaise, and elevated inflammatory markers in blood serum were associated with higher itch severity, suggesting that systemic inflammation may amplify the itch signal. Additionally, Stolz et al. report that patients with depression showed an increased risk of experiencing more severe itch. Whether this finding stems from the psychological burden of itch, or whether depression itself might lead to worse itch, remains to be further investigated. The scientific literature suggests that both are true, indicating the presence of a bidirectional relationship. Furthermore, the authors showed that higher itch severity in CSU is linked to worse quality of life, as assessed by the disease-specific Chronic Urticaria Quality of Life questionnaire. Also, patients with more severe itch showed a higher rate of visits to the general practitioner and dermatologist or allergist and were more likely to have visited the emergency department in the previous twelve months. These findings point towards an important role of itch regarding the extent of quality of life-impairment and health care utilization among patients with CSU. Given its relevance in CSU, itch should be specifically assessed and treated to improve patient care. 

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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