The effect of stress on the onset of chronic spontaneous urticaria in the elderly

Introduction:
Chronic spontaneous urticaria (CSU) can occur at every age, however, knowledge of the elderly with CSU is limited.

Aim:
To examine the relationship between the onset of CSU and previous stressful life events, disease activity, and perceived general stress in the elderly age group.

Material and methods:
A hundred and sixty-four elderly patients with CSU were included. To evaluate urticaria activity, Turkish-validated seven days Urticaria Activity Score (UAS7) was used. Patients were questioned by physicians to respond “yes” or “no” to evaluate having stress, and their opinion on the relationship between a stressful event and onset of urticaria. Severity of stress level was assessed by using 10-point Visual Analogue Scale (VAS). Patients were divided into two groups according to the VAS. VAS ≤ 5 and > 5 were considered as patients with no stress (Group 1, n = 66), and patients with stress (Group 2, n = 98), respectively.

Results:
A hundred patients had at least one stressful life event within three months of the onset of CSU. There was a strong correlation between having stress and onset of CSU (r = 0.871, p < 0.001), a positive correlation was determined between VAS and UAS7 (r = 0.418, p < 0.001). Concomitant disease history and UAS7 were significantly higher in Group 2 than in Group 1 (p = 0.018 and p < 0.001, respectively).

Conclusions:
Stressful life events and perceived high stress may be a trigger for CSU in the elderly. To control CSU in the elderly, having stressful life events should be questioned and multidisciplinary management including psychiatry consultation should be done.