Background: The coexistence of allergic diseases and chronic urticaria (CU) is not uncommon. Our aim was to show the prevalence of allergic diseases in chronic urticaria patients and whether possible risk factors precipitate the development of these conditions. Methods: The data of 953 patients diagnosed with CU in our adult allergy clinic between January 1991 and June 2006 were retrospectively evaluated. Results: The mean ages of the CU patients with and without non-steroidal anti-inflammatory drug hypersensitivity (NSAIDH) were 39.0 ± 11.8 and 36.7± 12.3, respectively (p = 0.014). There was a female predominance in both groups (74.6 and 68.2%, respectively, p = 0.06). Apparently, some conditions occurred significantly more often in CU patients with NSAIDH compared to those without NSAIDH: 16.4 and 8.4% for asthma (p < 0.001), 4.2 and 0.8% for nasal polyps (p < 0.01), 20.8 and 7.3% for antibiotic hypersensitivity (p < 0.001), 21.6 and 12.3% for metal sensitization (p < 0.01), and 8 and 0.6% for familial NSAIDH (p < 0.001), respectively. Dermographism was more common in CU patients without NSAIDH compared to those with NSAIDH (29.4 and 21.2%, respectively; p < 0.05). NSAIDH increased the risk of asthma and rhinitis development [odds ratios: 52.9 (18.1–154.6) and 5.2 (2.0–13.4)]. Conclusion: Based on our data, the incidence rates of asthma, nasal polyps, antibiotic hypersensitivity, metal sensitization and familial NSAIDH are increased in patients with CU with NSAIDH compared to those with CU only. Coexistence of NSAIDH and CU increases the risk of developing asthma and rhinitis.

Keywords:
Asthma, Chronic urticaria, Drug allergy, Nasal polyps, NSAID hypersensitivity, Rhinitis, Urticaria
1.
Baxi S, Dinakar C: Urticaria and angioedema. Immunol Allergy Clin North Am 2005;25:353–367.
2.
Zuberbier T, Bindsley-Jensen C, Canonica W, Garttan CEH, Greaves MW, Henz BM, et al: EAACI/GALEN/EDF guideline: definition, classification and diagnosis of urticara. Allergy 2006;61:316–320.
3.
Kaplan A: Urticaria and angioedema; in Adkinson NF, Yunginger JW, Buse WW, Bochner BS, Holgate ST, Simons FER (eds): Middleton’s Allergy Principles and Practice. Philadelphia, Mosby, 2003, pp 1537–1558.
4.
Nettis E, Pannofino A, D’Aprile C, Ferrannini A, Tursi A: Clinical and laboratory investigations. Clinical and aetiological aspects in urticaria and angioedema. Br J Dermatol 2003;148:501–506.
5.
Settipane GA, Chafee FH, Klein DE: Aspirin hypersensitivity. II. A prospective study in an atopic and normal population. J Allergy Clin Immunol 1974;53:200–204.
6.
Szczeklik A: NSAIDs, allergy and asthma. Drugs 1986;32(suppl 4):148–163.
7.
Kalyoncu AF, Karakoca Y, Demir AU, et al: Prevalence of asthma and allergic diseases in Turkish university students. Allergol Immunopathol (Madr) 1996;24:152–157.
8.
Settipane GA: Aspirin and allergic diseases: a review. Am J Med 1983;74:102–109.
9.
Szczeklik A, Gryglewski RJ, Czerniawska-Mysik G: Clinical patterns of hypersensitivity to nonsteroidal antiinflammatory drugs and their pathogenesis. J Allergy Clin Immunol 1977;60:276–284.
10.
Hedman J, Kaprio J, Poussa T, Nieminen MM: Prevalence of asthma, aspirin intolerance, nasal polyposis and chronic obstructive pulmonary disease in a population-based study. Int J Epidemiol 1999;28:717–722.
11.
Grattan CEH: Aspirin sensitivity and urticaria. Clin Exp Dermatol 2003;28:123–127.
12.
Global Strategy for Asthma Management and Prevention GINA Workshop Report: NIH Publ No 02-3659 (updated 2002).
13.
Kalyoncu AF, Karakaya G, Sahin AA, Baris YI: Occurrence of allergic conditions in asthmatics with analgesic intolerance. Allergy 1999;54:428–435.
14.
Bousquet J, Van Cauwenberge P, Khaltaev N: Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 2001;5(suppl):S147–S334.
15.
Johansson SGO, Hourihane JOB, Bousquet J, Buruijnzeel-Koomen C, Dreborg S, Haahtela T, et al: A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy 2001;56:813–824.
16.
Karakaya G, Demir AU, Kalyoncu AF: From analgesic intolerance to analgesic induced asthma: are there some determinants? Allergol Immunopathol (Madr) 2000;28:229–237.
17.
Celik G, Mungan D, Ozer F, et al: Clinical features and atopy profile in Turkish subjects with analgesic intolerance. J Asthma 2002;39:101–106.
18.
Karakaya G, Kalyoncu AF: Experience of 11 years on analgesic intolerancein Turkey. Pain Clinic 2002, pp 1–7.
19.
Gollapudi RR, Teirstein PS, Stevenson DD, Simon RA: Aspirin sensitivity: Implications for patients with coronary artery disease. JAMA 2004;292:3017–3023.
20.
Asero R: Hypersensitivity to nonsteroidal anti-inflammatory drugs might precede by years the onset of chronic urticaria. J Allergy Clin Immunol 2003;111:1095–1098.
21.
Stevenson DD: Aspirin and NSAID sensitivity. Immunol Allergy Clin North Am 2004;24:491–505.
22.
Moore-Robinson M, Warin RP: Effects of salicylates in urticaria. Br Med J 1967;iv:262–264.
23.
Doeglas HMG: Reactions to aspirin and food additives in patients with chronic urticaria, including the physical urticarias. Br J Dermatol 1975;93:135–143.
24.
Mastalerz L, Setkowics M, Sanak M, Szczelik A: Hypersensitivity to aspirin: Common eicosanoid alterations in urticaria and asthma. J Allergy Clin Immunol 2004;113:771–775.
25.
Kim SH, Ye YM, Lee SK, Park HS: Genetic mechanism of aspirin-induced urticaria/angioedema. Curr Opin Allergy Clin Immunol 2006;6:266–270.
26.
Asore R, Madonini E: Bronchial hyperresponsiveness is a common feature in patients with chronic urticaria. J Investig Allergol Clin Immunol 2006;16:19–23.
27.
Humphreys F, Hunter JAA: The characteristics of urticaria in 390 patients. Br J Dermatol 1998;138:635–638.
28.
Mastalerz L, Setkowicz M, Sanak M, Rybarczyk H, Szczeklik A: Familial aggregation of aspirin-induced urticaria and leukotriene C4 synthase allelic variant. Br J Dermatol 2006;154:256–260.
29.
Grattan C, Powell S, Humphreys F: Management and diagnostic guidelines for urticaria and angioedema. Br J Dermatol 2001;144:708–714.
30.
Greaves M: Chronic urticaria. J Allergy Clin Immunol 2000;105:664–672.
31.
Kaplan AP: Chronic urticaria: pathogenesis and treatment. J Allergy Clin Immunol 2004;114:465–474.
32.
Gul U, Cakmak SK, Olcay I, Kılıc A, Gonul M: Nickel sensitivity in asthma patients. J Asthma 2007;44:383–384.
© 2009 S. Karger AG, Basel
2009
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.