Allergy Asthma Immunol Res.  2017 Jul;9(4):373-377. 10.4168/aair.2017.9.4.373.

Increased Risk of Chronic Spontaneous Urticaria in Patients With Autoimmune Thyroid Diseases: A Nationwide, Population-based Study

• Kim YS
• Han K
• Lee JH
• Kim NI
• Roh JY
• Seo SJ
• Song HJ
• Lee MG
• Choi JH
• Park YM

• KMID: 2378201
• DOI: http://doi.org/10.4168/aair.2017.9.4.373

Abstract

There was no previous population-based study on the comparison of the risk of chronic spontaneous urticaria (CSU) between autoimmune thyroid diseases (AITD) and age- and gender-matched controls. The primary objective of this study was to evaluate the risk of CSU after diagnosis of AITD using national registry data from Korea. The secondary objective was to evaluate other risk factors of CSU. Based on the disease code diagnoses in 2003-2005, we composed an AITD group (n=3,659) and an age- and gender-matched control group (n=18,295). Each patient was tracked for whether CSU occurs or not until 2013. After adjusting for demographic differences and comorbidities, patients with AITD had a significantly higher rate of CSU compared to the control group (hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.25-1.70; P<0.001). Among the AITD patients, the adjusted HR for CSU was higher in patients with Hashimoto's thyroiditis (HR, 1.50) than in those with Grave's disease (HR, 1.33), although the difference was not statistically significant (P=0.368). Analysis of CSU patients associated with AITD showed that female patients had a significantly higher risk of CSU compared to male ones (HR, 1.34; P=0.001) and that those with allergic rhinitis (HR, 1.51; P<0.001), atopic dermatitis (HR, 2.44; P<0.001), and asthma (HR, 1.50; P<0.001) had a significantly higher risk of CSU compared to patients without respective diseases. Our results demonstrated that AITD could be significantly associated with an increased risk of CSU.

Keyword

Graves disease; hashimoto disease; urticaria

MeSH Terms

Asthma
Comorbidity
Dermatitis, Atopic
Diagnosis
Female
Graves Disease
Hashimoto Disease
Humans
Korea
Male
Rhinitis, Allergic
Risk Factors
Thyroid Diseases*
Thyroid Gland*
Thyroiditis
Urticaria*

Reference

1. Mozena JD, Tiñana A, Negri J, Steinke JW, Borish L. Lack of a role for cross-reacting anti-thyroid antibodies in chronic idiopathic urticaria. J Invest Dermatol. 2010; 130:1860–1865. PMID: 20182447.

2. Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014; 69:868–887. PMID: 24785199.

3. Maurer M, Church MK, Gonçalo M, Sussman G, Sánchez-Borges M. Management and treatment of chronic urticaria (CU). J Eur Acad Dermatol Venereol. 2015; 29(Suppl 3):16–32.

4. Fine LM, Bernstein JA. Guideline of chronic urticaria beyond. Allergy Asthma Immunol Res. 2016; 8:396–403. PMID: 27334777.

5. Weetman AP. Autoimmune thyroid disease. Autoimmunity. 2004; 37:337–340. PMID: 15518055.

6. Confino-Cohen R, Chodick G, Shalev V, Leshno M, Kimhi O, Goldberg A. Chronic urticaria and autoimmunity: associations found in a large population study. J Allergy Clin Immunol. 2012; 129:1307–1313. PMID: 22336078.

7. Lapi F, Cassano N, Pegoraro V, Cataldo N, Heiman F, Cricelli I, et al. Epidemiology of chronic spontaneous urticaria: results from a nationwide, population-based study in Italy. Br J Dermatol. 2016; 174:996–1004. PMID: 26872037.

8. Lee J, Lee JS, Park SH, Shin SA, Kim K. Cohort profile: the National Health Insurance Service-National Sample Cohort (NHIS-NSC), South Korea. Int J Epidemiol. Forthcoming 2016.

9. Cherepanov D, Raimundo K, Chang E, Eagan M, Zazzali JL, Solari PG, et al. Validation of an ICD-9-based claims algorithm for identifying patients with chronic idiopathic/spontaneous urticaria. Ann Allergy Asthma Immunol. 2015; 114:393–398. PMID: 25771155.

10. Verneuil L, Leconte C, Ballet JJ, Coffin C, Laroche D, Izard JP, et al. Association between chronic urticaria and thyroid autoimmunity: a prospective study involving 99 patients. Dermatology. 2004; 208:98–103. PMID: 15056996.

11. Leznoff A, Sussman GL. Syndrome of idiopathic chronic urticaria and angioedema with thyroid autoimmunity: a study of 90 patients. J Allergy Clin Immunol. 1989; 84:66–71. PMID: 2754146.

12. Díaz-Angulo S, López-Hoyos M, Muñoz Cacho P, Fernández M, López-Escobar M, Rodríguez F, et al. Prevalence of thyroid autoimmunity in spanish patients with chronic idiopathic urticaria: a case-control study involving 343 subjects. J Eur Acad Dermatol Venereol. 2016; 30:692–693. PMID: 25627749.

13. Aamir IS, Tauheed S, Majid F, Atif A. Frequency of autoimmune thyroid disease in chronic urticaria. J Coll Physicians Surg Pak. 2010; 20:158–161. PMID: 20392376.

14. Najib U, Bajwa ZH, Ostro MG, Sheikh J. A retrospective review of clinical presentation, thyroid autoimmunity, laboratory characteristics, and therapies used in patients with chronic idiopathic urticaria. Ann Allergy Asthma Immunol. 2009; 103:496–501. PMID: 20084843.

15. Gangemi S, Saitta S, Lombardo G, Patafi M, Benvenga S. Serum thyroid autoantibodies in patients with idiopathic either acute or chronic urticaria. J Endocrinol Invest. 2009; 32:107–110. PMID: 19411805.

16. Cebeci F, Tanrikut A, Topcu E, Onsun N, Kurtulmus N, Uras AR. Association between chronic urticaria and thyroid autoimmunity. Eur J Dermatol. 2006; 16:402–405. PMID: 16935798.

17. Altrichter S, Peter HJ, Pisarevskaja D, Metz M, Martus P, Maurer M. IgE mediated autoallergy against thyroid peroxidase--a novel pathomechanism of chronic spontaneous urticaria? PLoS One. 2011; 6:e14794. PMID: 21532759.

18. Shin YS, Suh DH, Yang EM, Ye YM, Park HS. Serum specific IgE to thyroid peroxidase activates basophils in aspirin intolerant urticaria. J Korean Med Sci. 2015; 30:705–709. PMID: 26028921.

19. Kadiyala R, Peter R, Okosieme OE. Thyroid dysfunction in patients with diabetes: clinical implications and screening strategies. Int J Clin Pract. 2010; 64:1130–1139. PMID: 20642711.

20. Perros P, McCrimmon RJ, Shaw G, Frier BM. Frequency of thyroid dysfunction in diabetic patients: value of annual screening. Diabet Med. 1995; 12:622–627. PMID: 7554786.

21. Duntas LH, Orgiazzi J, Brabant G. The interface between thyroid and diabetes mellitus. Clin Endocrinol (Oxf). 2011; 75:1–9. PMID: 21521298.

22. D'Angelo G, Marseglia L, Manti S, Colavita L, Cuppari C, Impellizzeri P, et al. Atopy and autoimmune thyroid diseases: melatonin can be useful? Ital J Pediatr. 2016; 42:95. PMID: 27814774.

23. Pedullà M, Miraglia Del Giudice M, Fierro V, Arrigo T, Gitto E, Salpietro A, et al. Atopy as a risk factor for thyroid autoimmunity in children. J Biol Regul Homeost Agents. 2012; 26:S9–S14. PMID: 22691261.

24. Pedullá M, Fierro V, Papacciuolo V, Alfano R, Ruocco E. Atopy as a risk factor for thyroid autoimmunity in children affected with atopic dermatitis. J Eur Acad Dermatol Venereol. 2014; 28:1057–1060. PMID: 24118567.

25. Chang HW, Cheng HM, Yen HR, Hsu CY, Lee YC, Chiang JH, et al. Association between chronic idiopathic urticaria and hypertension: a population-based retrospective cohort study. Ann Allergy Asthma Immunol. 2016; 116:554–558. PMID: 27264565.

26. Chung SD, Wang KH, Tsai MC, Lin HC, Chen CH. Hyperlipidemia is associated with chronic urticaria: a population-based study. PLoS One. 2016; 11:e0150304. PMID: 26964045.

27. Ye YM, Jin HJ, Hwang EK, Nam YH, Kim JH, Shin YS, et al. Co-existence of chronic urticaria and metabolic syndrome: clinical implications. Acta Derm Venereol. 2013; 93:156–160. PMID: 22948845.

28. Isik SR, Karakaya G, Celikel S, Demir AU, Kalyoncu AF. Association between asthma, rhinitis and NSAID hypersensitivity in chronic urticaria patients and prevalence rates. Int Arch Allergy Immunol. 2009; 150:299–306. PMID: 19494528.

29. Nettis E, Pannofino A, D'Aprile C, Ferrannini A, Tursi A. Clinical and aetiological aspects in urticaria and angio-oedema. Br J Dermatol. 2003; 148:501–506. PMID: 12653742.