Comorbidities
A total of 87 patients (34.8%) had at least one atopic disease (Figure
1A): in 64.4% (56/87) the diagnosis of atopic disease was established
before or concurrently with CSU. The atopic comorbidities found in the
study cohort were: AD (n=43, 17.2%), AR (n=40, 16.1%), asthma (n=33,
13.3%) and food allergy (n=8, 3.2%). Thirty patients (12%) had more
than one atopic co-morbidity. After excluding the patients diagnosed
with AD, the prevalence of atopic comorbidities did not differ
significantly: AR (n=27, 13% vs. 16.1% in the total cohort, p=0.36),
asthma (n=21, 10.1% vs. 13.3% in the total cohort, p=0.3) and food
allergy (n=7, 3.4% vs. 3.2% in the total cohort, p=0.9). Consequently,
the rest of the analyses are presented for the entire group.
No correlation was found between the prevalence of AR, AD, asthma, or
food allergy and the duration of CSU. Furthermore, there was no
difference in the probability of relapse and the presence of atopic
disease as a co-morbidity (9.8% vs. 9.2%, p=0.87).
The prevalence of the different atopic diseases in CSU patients and the
general pediatric population in Israel and in the world was compared
(Figure 1B): The prevalence of AD in two age groups (4-8 years and 13-18
years) of the study population was significantly different compared to
the general population in Israel7,23,24 and in the
world25 (p<0.01). Differences in the
prevalence of allergic rhinitis were statistically significant only in
adolescents when compared to the general population of adolescents in
Israel7,23,26 and in the world27(p<0.01). The differences in the prevalence of food allergy
between participants in the current study and the general world
population28,29 were statistically significant in
children age 4-8 years (p<0.05) but did not reach significance
when compared to adolescents in the current study and adolescents in
Israel7,30 (p=0.83). Differences in the prevalence of
asthma between the current study and the general population in
Israel7,24,26 and in the world 31did not reach significance in any age group (p=0.46–0.99).
Overall, 18 patients (7.2%) had a concomitant autoimmune disease
compared to 1.9% in the general adolescent population in Israel
(p<0.01). Nine (3.6%) were diagnosed with thyroid disease, 7
with hypothyroidism and 2 with hyperthyroidism. Psoriasis was found in 6
patients (2.4%), type I diabetes mellitus in 2 patients (0.8%) and 1
patient was diagnosed with juvenile rheumatoid arthritis (0.4%). Celiac
disease, irritable bowel disease and SLE were not diagnosed in our
cohort. IBS was diagnosed in 5 patients (2%).
Seven patients (2.8%) had psychiatric disorders, including depression,
anxiety, bipolar disorder, and schizophrenia. All were diagnosed after
the first CSU episode.