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Study Identifies Association Between Development of Psoriasis, Chronic Urticaria

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Key Takeaways

  • Chronic urticaria is associated with a 3.6-fold increased risk of psoriasis development, suggesting a potential causal relationship.
  • The study utilized a retrospective cohort design with data from Taiwan's National Health Insurance Research Database.
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These data may provide useful information for additional studies on the pathogenesis and treatments of urticaria-related psoriasis.

Study Identifies Association Between Development of Psoriasis, Chronic Urticaria

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Individuals with chronic urticaria have an approximately 3.6-fold higher risk of psoriasis development, new findings suggest, although the mechanism underlying such an association between urticaria and psoriasis is not yet established.1

These data represent the conclusion of new research authored by Lin-Hong Shi, of JC School of Public Health and Primary Care at the Chinese University of Hong Kong, and a team of investigators. Shi and colleagues noted that there are common immune cells between psoriasis and mediators with urticaria to some large extent.

Some of these mediators have been identified and Th-17 plays an important role in the pathogenesis of the 2 chronic inflammatory skin diseases.2 The investigators noted that it was reasonable to hypothesize that a link could be observed between urticaria and psoriasis.

“However, to date, there is no evidence available to support this relationship,” Shi and colleagues wrote. “Therefore, we [hypothesize] that [chronic urticaria] may play a causal role in psoriasis development and show for the first time in this observational and mendelian randomization study.”1

Trial Design and Background

The research team conducted their research using a retrospective cohort study design, evaluating outpatient and inpatient data that was drawn from the Longitudinal Health Insurance Database 2000. This database includes a subset of Taiwan’s National Health Insurance Research Database (NHIRD).

The investigators focused on individuals with new diagnoses of chronic urticaria in the period between 2000 - 2010, alongside a control group who did not have chronic urticaria. They ensured comparability by applying propensity score matching at a 1:1 ratio, matching each of the trial participants based on their sex, age, and baseline comorbidities.

The investigative team tracked each of the subjects from their index date until either they are diagnosed with psoriasis, until withdrawal from the insurance system, or up until the study’s December 2013 endpoint.

The team determined relative risk (RR), incidence rates per 1,000 person-years, and hazard ratios (HR) for psoriasis. They also implemented Cox proportional hazards regression models adjusted for covariates and sought additional validation through a 2-sample Mendelian randomization analysis.

Notable Findings on Chronic Urticaria and Psoriasis

The investigators concluded their research having involved an equal set of controls and patients with chronic urticaria, with a total of 27,481 individuals per group. They determined that at baseline, characteristics such as sex, age, and comorbidities were similar between both cohorts.

Following the researchers’ univariate and multivariate analyses, the findings suggested that there was a significantly elevated risk of psoriasis in individuals reporting chronic urticaria compared to those in the control arm of the analysis. The results of their Kaplan–Meier analysis also indicated that incidence of psoriasis development was significantly increased among those with urticaria (P < 0.001).

The investigators further noted that their subgroup analysis consistently demonstrated such an increased risk across the varying clinical and demographic categories. Their Mendelian randomization analysis confirmed the link in genetically predicted urticaria individuals who were noted as being of Asian descent.

The research team found that there was an odds ratio (OR) of 3.61 per 1.28 increased risk for psoriasis vulgaris and a ratio of 1.44 per 0.36 for psoriasis. However, they did not observe a reverse association.

The team highlighted that this research represents the first longitudinal study to establish an association between chronic urticaria and psoriasis. Despite the fact that the precise mechanism underlying such a link remains unclear, they added that it is likely that shared inflammatory pathways contribute to both of the conditions.

“This is the first longitudinal follow-up study to investigate an increased risk of psoriasis in patients with [chronic urticaria], which was validated by MR analyses,” they wrote. “Although the nonsignificant risk of psoriasis vulgaris or psoriasis is found in MR analyses, it should be noted that the occurrence of a disease is always multifactorial, not just caused by genes.”1

References

  1. Shi, L.-H., Huo, A.-P., Wang, Y.-H. and Wei, J.C.-C. (2025), Chronic Urticaria Is Associated With an Increased Risk of Psoriasis: An Observational and Validation Study. Clin Exp Allergy. https://doi.org/10.1111/cea.70000.
  2. E. Bettelli, Y. Carrier, W. Gao, et al., “Reciprocal Developmental Pathways for the Generation of Pathogenic Effector TH17 and Regulatory T Cells,” Nature 441, no. 7090 (2006): 235–238.
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