Ann Dermatol.  2015 Aug;27(4):423-430. 10.5021/ad.2015.27.4.423.

Vitamin D as a Marker for Disease Severity in Chronic Urticaria and Its Possible Role in Pathogenesis

• Woo YR
• Jung KE
• Koo DW
• Lee JS

• KMID: 2171500
• DOI: http://doi.org/10.5021/ad.2015.27.4.423

Abstract

BACKGROUND
Chronic urticaria is defined as repeated episodes of wheals lasting for 6 weeks or longer. Nowadays, the role of vitamin D in various chronic diseases is a matter of great interest, but limited data is available on the vitamin D status in patients with chronic urticaria.
OBJECTIVE
The goal of this study was to investigate the relationship between vitamin D status and clinical characteristics of chronic urticaria.
METHODS
The clinical records of 72 patients with chronic urticaria, 26 with acute urticaria and 26 with atopic dermatitis, along with 72 healthy controls, were retrospectively reviewed.
RESULTS
The serum 25-(OH)D3 level was found to be significantly reduced in patients with chronic urticaria compared to those in the other groups. In particular, the proportion of patients with critically low vitamin D levels (<10 ng/ml) was significantly higher in the chronic urticaria group than in the other groups. The serum vitamin D levels showed significant negative associations with urticaria activity score and disease duration. In addition, serum vitamin D levels were significantly lower in subjects with a positive autologous serum skin test than in subjects with a negative result.
CONCLUSION
In conclusion, the serum vitamin D level was more likely to be critically low in patients with chronic urticaria, and an inverse relationship with disease severity and disease duration was observed. These findings may open up the possibility of the clinical use of vitamin D as a contributing factor in the pathogenesis of chronic urticaria and a predictive marker for disease activity in chronic urticaria.

Keyword

Chronic urticaria; Vitamin D; 25-(OH)D3

MeSH Terms

Chronic Disease
Dermatitis, Atopic
Humans
Retrospective Studies
Skin Tests
Urticaria*
Vitamin D*
Vitamins*
Vitamin D
Vitamins

Figure

• 

  Fig. 1 Levels of serum 25-(OH)D3 in patients with chronic urticaria, acute urticaria, atopic dermatitis and healthy controls. Serum 25-(OH)D3 levels were significantly reduced in patients with chronic urticaria compared with acute urticaria (p=0.024), atopic dermatitis (p=0.008) and healthy controls (p<0.001). Data are presented as Box and Whisker plots ('○' representing data points >1.5 interquartile range). Sample sizes were as follows: chronic urticaria, n=72; acute urticaria, n=26; atopic dermatitis, n=26; healthy control, n=72. *p<0.05, **p<0.001.

• 

  Fig. 2 Proportion of the subjects in chronic urticaria, healthy control, acute urticaria and atopic dermatitis in the serum vitamin D level groups. The proportion of subjects with critically low vitamin D was significantly higher in patients with chronic urticaria (49%) compared to patients with acute urticaria (26%) (p<0.002), atopic dermatitis (28%) (p<0.004) and healthy controls (8%) (p<0.001).

• 

  Fig. 3 Serum 25-(OH)D3 levels of chronic urticaria patients according to autologous serum skin test (ASST) results. The serum 25-(OH)D3 levels were significantly lower in ASST positive subjects than ASST negative subjects (p=0.034), *p<0.05. Data are presented as Box and Whisker plots. Sample sizes were as follows: ASST negative, n=44; ASST positive, n=28.

• 

  Fig. 4 Patients with chronic urticaria grouped according to the autologous serum skin test (ASST) and serum vitamin D levels. The proportion of patients with critically low vitamin D was higher in the ASST positive group (60%) than the ASST negative group (32%) (p=0.021), *p<0.05.

• 

  Fig. 5 The trend of association between urticaria activity score (UAS) and serum 25-(OH)D3 levels in patients with chronic urticaria. The serum 25-(OH)D3 levels showed a significant negative trend of association with UAS in chronic urticaria patient (p<0.001; Jonckheere-Terpstra test). Data are presented as Box and Whisker plots, **p<0.001. Sample sizes were as follows: mild, n=22; moderate, n=25; severe, n=26.

• 

  Fig. 6 The trend of association between disease duration and serum 25-(OH)D3 levels in patients with chronic urticaria. The serum 25-(OH)D3 levels showed a significant negative trend of association with disease duration (p=0.008; Jonckheere-Terpstra test). Data are presented as Box and Whisker plots, *p<0.05. Sample sizes were as follows: <6 months, n=36; <1 year, n=13; <3 years, n=12; ≥3 years, n=12.

• 

  Fig. 7 Serum 25-(OH)D3 levels in patients with chronic urticaria and healthy controls according to the season. Patient with chronic urticaria had significantly lower serum 25-(OH)D3 levels than the healthy control group. Sample sizes were as follows: In patients with chronic urticaria, winter, n=17; spring, n=23; autumn, n=14; summer, n=18; in healthy controls, winter, n=16; spring, n=23; autumn, n=15; summer, n=18. Data are presented as Box and Whisker plots, **p<0.01. CU: chronic urticaria, HC: healthy controls.

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