Chronic spontaneous urticaria (CSU) symptoms—such as recurrent hives, angioedema, itching, and pain—have a substantial impact on patients’ quality of life (QOL) and may lead to psychiatric consequences.  Recent studies have shown that chronic urticaria is associated with higher risk of psychiatric disorders, with anxiety, depression, and somatoform disorders being the most common. Psychiatric disorders can be a triggering factor, an underlying cause, or a consequence of chronic urticaria, although the connection between these two entities has not yet been clarified, the authors of a recent study explain.

For a paper published in the Asian Pacific Journal of Allery and Immunology, the researchers aimed to determine if depressive symptoms were present in patients with CSU who received omalizumab, if depression scores improved with omalizumab treatment, and whether the presence of depressive symptoms impaired treatment response. “Many studies and trials have shown that omalizumab improves QOL significantly in patients with CSU,” the study authors write. “However, few studies have investigated whether it improves depressive symptoms or not and whether presence of comorbid psychiatric conditions affects treatment responses.  In our study, we sought to not only observe if depression scores change after treatment, but if the presence of depressive symptoms have an impact on treatment responses.”

Patients with CSU who received at least three injections of omalizumab were included in the study. Patient characteristics—including age, gender, disease duration, autologous serum skin test (ASST), concomitant angioedema, concurrent chronic inducible urticaria (CINDU), and daily life stress—were reviewed retrospectively. Changes in Urticaria Activity Score (UAS), Chronic Urticaria Quality of Life Questionnaire (CU-Q2OL), beck Depression Inventory (Beck-D), an Urticaria Control Test (UCT) scores were compared before and after treatment.

Depression May Be a Consequence of CSU

Of 49 patients, 20 (40.8%) had depressive symptoms at baseline. After treatment, UAS, CU-Q2OL, and Beck-D scores decreased and UCT scores increased significantly. UCT scores were lower at baselines and at the third month following treatment in patients with depressive symptoms compared to patients without.

In addition, the authors note that omalizumab non-responders had higher baseline Beck-D scores. The number of omalizumab non-responders was significantly higher among patients with depressive symptoms compared to patients without (40% vs 13.8%). Only six patients scored as having depressive symptoms after treatment; of these six patients, only one was an omalizumab responder.

Depression seems to occur as a consequence of CSU, rather being a cause of it, according to the study authors, and the presence of depression might impair treatment responses. “We believe that the presence of psychiatric comorbidities should be managed accordingly if they coexist with CSU since depression may exacerbate the symptoms and impair the QOL by changing the perception of the patients and may impair response to treatment. Omalizumab not only provides symptom control for urticaria, but also improves psychological conditions of patients. Our research emphasizes the necessity of psychological evaluation and a comprehensive, multidisciplinary approach including psychiatrists in the management of this chronic, debilitating disease.”



Depression Scores Change Significantly After Omalizumab Treatment in Patients with Chronic Spontaneous Urticaria


Can, P, et al. Asian Pac J Allergy Immunol. 2021, Feb 21. [ePub ahead of print].