Moderate-to-severe chronic spontaneous urticaria is associated with increased risk of immune-mediated diseases: A population-based study

Kimberly Smart, Andrea Ure, Nicole Johnsen, Shaliz Aflatooni, Julian A Cortes, Gabriela Palma, Yvonne Nong, Andrea J Borba, Paul C Levins and April W Armstrong

PLOS ONE, 2026, vol. 21, issue 9, 1-12

Abstract: Chronic spontaneous urticaria (CSU) is characterized by the idiopathic appearance of wheals and/or angioedema lasting more than six weeks. There is a critical need to evaluate whether the severity of CSU influences the risk of future immune-mediated comorbidities. We aim to evaluate if patients with moderate-to-severe chronic spontaneous urticaria (CSU) have an increased risk of developing immune-mediated comorbidities compared with matched patients with mild CSU. We conducted a retrospective cohort study using the TriNetX US Collaborative Network database from 2014–2026. We propensity matched patients with ≥2 ICD-10 diagnoses of idiopathic urticaria treated with omalizumab, dupilumab, or cyclosporine (moderate-to-severe disease) to age-, sex-, race-, ethnicity-, comorbidity-, and family history-matched counterparts who were never treated with biologics or cyclosporine (mild disease). After matching, 16,413 patients were included in the moderate-to-severe group, and 16,413 patients were included in the mild group. Patients with moderate-to-severe CSU had a significantly increased risk of developing rheumatoid arthritis OR=1.34 (95% CI: 1.12 to 1.60, p = 0.001) and Sjögren’s syndrome OR=1.04 (1.63–2.56, p

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0358883

DOI: 10.1371/journal.pone.0358883

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