Introduction: Asthma and chronic urticaria (CU) are two high prevalent diseases and often coexist. The underlying relationship and potential immunological mechanism between the two diseases are still unclear. The objective of this study was to investigate the clinical and immunological feature of asthma comorbid with CU. Methods: A retrospective study was conducted. Fifty patients with asthma comorbid CU, 50 patients with asthma, and 50 patients with CU alone were included. Age and sex of the patients enrolled were matched. Data of demographic characteristics, clinical manifestations including disease severity (frequency of symptoms, age of onset, disease duration, symptom score, complication with allergic rhinitis) as well as serum immunological index including total IgE (tIgE), allergen-specific IgE (sIgE), and food-specific IgG4 (FS-IgG4), were collected and analyzed. Results: No significant differences in the frequency of symptoms, age of onset, and disease duration were found among the three groups. The score of asthma control test (ACT) in patients with asthma comorbid CU was significantly lower than that of asthma (p = 0.005); however, compared with patients with CU, the 7-day urticaria activity score (UAS7) of patients with asthma comorbid CU did not show obvious differences. Immunological index showed that the positive rates of tIgE, house dust mite (HDM)-sIgE, and FS-IgG4 were different among the three groups (p < 0.05). Patients with asthma comorbid CU had the highest rate of positive tIgE, moderate and severe positive sIgE to HDM. Egg-specific IgG4 (egg-sIgG4) had the highest positive rate in all groups. Patients of asthma comorbid CU obtained the highest rate of severe positive of egg-sIgG4. Conclusion: Our results demonstrated that patients with asthma comorbid CU have lower control level of asthma symptoms, higher tIgE and HDM-sIgE level, and highest rate of severe positive egg-sIgG4. These results indicate that comorbidity of CU in asthma obviously increases the severity of allergens.

1.
Papadopoulos
J
,
Karpouzis
A
,
Tentes
J
,
Kouskoukis
C
.
Assessment of interleukins IL-4, IL-6, IL-8, IL-10 in acute urticaria
.
J Clin Med Res
.
2014
;
6
(
2
):
133
7
.
2.
Saluja
R
,
Khan
M
,
Church
MK
,
Maurer
M
.
The role of IL-33 and mast cells in allergy and inflammation
.
Clin Transl Allergy
.
2015
;
5
:
33
.
3.
Kessel
A
,
Yaacoby-Bianu
K
,
Vadasz
Z
,
Peri
R
,
Halazs
K
,
Toubi
E
.
Elevated serum B-cell activating factor in patients with chronic urticaria
.
Hum Immunol
.
2012
;
73
(
6
):
620
2
.
4.
Venkatesan
P
.
2023 GINA report for asthma
.
Lancet Respir Med
.
2023
;
11
(
7
):
589
.
5.
Yorgancıoğlu
A
,
Reddel
HK
;
GINA Board of Directo
;
rs and GINA Science Committee
.
Global initiative for asthma: 30 years of promoting evidence-based asthma care
.
Allergy
.
2023
;
78
(
7
):
1737
9
.
6.
Zuberbier
T
,
Abdul Latiff
AH
,
Abuzakouk
M
,
Aquilina
S
,
Asero
R
,
Baker
D
, et al
.
The international EAACI/GA2LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria
.
Allergy
.
2022
;
77
(
3
):
734
66
.
7.
Fricke
J
,
Ávila
G
,
Keller
T
,
Weller
K
,
Lau
S
,
Maurer
M
, et al
.
Prevalence of chronic urticaria in children and adults across the globe: systematic review with meta-analysis
.
Allergy
.
2020
;
75
(
2
):
423
32
.
8.
Staubach
P
,
Bilo
B
,
Fluhr
JW
,
Krause
K
,
Kulthanan
K
,
Salman
A
, et al
.
UCOMB-real life data: treatment strategies for chronic urticaria patients with comorbidities
.
J Dermatolog Treat
.
2024
;
35
(
1
):
2329784
.
9.
Church
MK
,
Kolkhir
P
,
Metz
M
,
Maurer
M
.
The role and relevance of mast cells in urticaria
.
Immunol Rev
.
2018
;
282
(
1
):
232
47
.
10.
Zhang
DG
,
Zahid
JA
,
Ali
Z
,
Thomsen
SF
.
Risk of atopic disorders in patients with chronic urticaria: a systematic review and meta-analysis
.
Dermatology
.
2023
;
239
(
1
):
32
44
.
11.
Cohen
S
,
Berkman
N
,
Picard
E
,
Levi
T
,
Derazne
E
,
Tzur
D
, et al
.
Co-morbidities and cognitive status in a cohort of teenagers with asthma
.
Pediatr Pulmonol
.
2016
;
51
(
9
):
901
7
.
12.
Vadasz
Z
,
Kessel
A
,
Hershko
AY
,
Maurer
M
,
Toubi
E
.
Seasonal exacerbation of asthma is frequently associated with recurrent episodes of acute urticaria
.
Int Arch Allergy Immunol
.
2016
;
169
(
4
):
263
6
.
13.
Tollefsen
E
,
Langhammer
A
,
Bjermer
L
,
Romundstad
P
,
Holmen
TL
.
Allergy: a systemic disease? The HUNT and Young-HUNT study, Norway
.
Pediatr Allergy Immunol
.
2008
;
19
(
8
):
730
6
.
14.
Ying
S
,
Kikuchi
Y
,
Meng
Q
,
Kay
AB
,
Kaplan
AP
.
TH1/TH2 cytokines and inflammatory cells in skin biopsy specimens from patients with chronic idiopathic urticaria: comparison with the allergen-induced late-phase cutaneous reaction
.
J Allergy Clin Immunol
.
2002
;
109
(
4
):
694
700
.
15.
Armentia
A
,
Alvarez
R
,
Moreno-González
V
,
Martín
B
,
Fernández
S
,
Martín
S
, et al
.
Occupational airborne contact urticaria, anaphylaxis and asthma in farmers and agronomists due to Bruchus pisorum
.
Contact Dermatitis
.
2020
;
83
(
6
):
466
74
.
16.
Celikel
S
,
Isik
SR
,
Demir
AU
,
Karakaya
G
,
Kalyoncu
AF
.
Are chronic urticaria, analgesic intolerance and seasonal rhinitis markers of different severities and phenotypes of the asthma they accompany
.
Allergol Immunopathol
.
2010
;
38
(
6
):
313
20
.
17.
Louis
R
,
Satia
I
,
Ojanguren
I
,
Schleich
F
,
Bonini
M
,
Tonia
T
, et al
.
European respiratory society guidelines for the diagnosis of asthma in adults
.
Eur Respir J
.
2022
;
60
(
3
):
2101585
.
18.
Krempski
JW
,
Dant
C
,
Nadeau
KC
.
The origins of allergy from a systems approach
.
Ann Allergy Asthma Immunol
.
2020
;
125
(
5
):
507
16
.
19.
Gans
MD
,
Gavrilova
T
.
Understanding the immunology of asthma: pathophysiology, biomarkers, and treatments for asthma endotypes
.
Paediatr Respir Rev
.
2020
;
36
:
118
27
.
20.
Giménez-Arnau
AM
,
DeMontojoye
L
,
Asero
R
,
Cugno
M
,
Kulthanan
K
,
Yanase
Y
, et al
.
The pathogenesis of chronic spontaneous urticaria: the role of infiltrating cells
.
J Allergy Clin Immunol Pract
.
2021
;
9
(
6
):
2195
208
.
21.
Zhou
B
,
Li
J
,
Liu
R
,
Zhu
L
,
Peng
C
.
The role of crosstalk of immune cells in pathogenesis of chronic spontaneous urticaria
.
Front Immunol
.
2022
;
13
:
879754
.
22.
Bousquet
J
,
Schünemann
HJ
,
Togias
A
,
Bachert
C
,
Erhola
M
,
Hellings
PW
, et al
.
Next-generation allergic rhinitis and its impact on asthma (ARIA) guidelines for allergic rhinitis based on grading of recommendations assessment, development and evaluation (GRADE) and real-world evidence
.
J Allergy Clin Immunol
.
2020
;
145
(
1
):
70
80.e3
.
23.
Nappi
E
,
Paoletti
G
,
Malvezzi
L
,
Ferri
S
,
Racca
F
,
Messina
MR
, et al
.
Comorbid allergic rhinitis and asthma: important clinical considerations
.
Expert Rev Clin Immunol
.
2022
;
18
(
7
):
747
58
.
24.
Khan
DA
.
Allergic rhinitis and asthma: epidemiology and common pathophysiology
.
Allergy Asthma Proc
.
2014
;
35
(
5
):
357
61
.
25.
Mastrorilli
C
,
Posa
D
,
Cipriani
F
,
Caffarelli
C
.
Asthma and allergic rhinitis in childhood: what’s new
.
Pediatr Allergy Immunol
.
2016
;
27
(
8
):
795
803
.
26.
Bousquet
J
,
Melén
E
,
Haahtela
T
,
Koppelman
GH
,
Togias
A
,
Valenta
R
, et al
.
Rhinitis associated with asthma is distinct from rhinitis alone: the ARIA-MeDALL hypothesis
.
Allergy
.
2023
;
78
(
5
):
1169
203
.
27.
Amat
F
,
Soria
A
,
Tallon
P
,
Bourgoin-Heck
M
,
Lambert
N
,
Deschildre
A
, et al
.
New insights into the phenotypes of atopic dermatitis linked with allergies and asthma in children: an overview
.
Clin Exp Allergy
.
2018
;
48
(
8
):
919
34
.
28.
Han
H
,
Roan
F
,
Ziegler
SF
.
The atopic march: current insights into skin barrier dysfunction and epithelial cell-derived cytokines
.
Immunol Rev
.
2017
;
278
(
1
):
116
30
.
29.
Wang
WL
,
Li
HY
,
Zhang
MS
,
Gao
PS
,
He
SH
,
Zheng
T
, et al
.
Thymic stromal lymphopoietin: a promising therapeutic target for allergic diseases
.
Int Arch Allergy Immunol
.
2013
;
160
(
1
):
18
26
.
30.
Haughney
J
,
Morice
A
,
Blyth
KG
,
Lee
AJ
,
Coutts
A
,
McKnight
E
, et al
.
A retrospective cohort study in severe asthma describing commonly measured biomarkers: eosinophil count and IgE levels
.
Respir Med
.
2018
;
134
:
117
23
.
31.
Balzar
S
,
Strand
M
,
Rhodes
D
,
Wenzel
SE
.
IgE expression pattern in lung: relation to systemic IgE and asthma phenotypes
.
J Allergy Clin Immunol
.
2007
;
119
(
4
):
855
62
.
32.
Ayakannu
R
,
Abdullah
NA
,
Raj
VL
,
Radhakrishnan
AK
,
Liam
CK
.
Clinical characteristics, cytokine profiles and plasma IgE in adults with asthma
.
Mol Immunol
.
2022
;
143
:
50
7
.
33.
Vidal
C
,
Lojo
S
,
Juangorena
M
,
Gonzalez-Quintela
A
.
Association between asthma and sensitization to allergens of dermatophagoides pteronyssinus
.
J Investig Allergol Clin Immunol
.
2016
;
26
(
5
):
304
9
.
34.
Thomas
WR
,
Hales
BJ
,
Smith
WA
.
House dust mite allergens in asthma and allergy
.
Trends Mol Med
.
2010
;
16
(
7
):
321
8
.
35.
Clayton
F
,
Fang
JC
,
Gleich
GJ
,
Lucendo
AJ
,
Olalla
JM
,
Vinson
LA
, et al
.
Eosinophilic esophagitis in adults is associated with IgG4 and not mediated by IgE
.
Gastroenterology
.
2014
;
147
(
3
):
602
9
.
36.
Schuyler
AJ
,
Wilson
JM
,
Tripathi
A
,
Commins
SP
,
Ogbogu
PU
,
Kruzsewski
PG
, et al
.
Specific IgG4 antibodies to cow’s milk proteins in pediatric patients with eosinophilic esophagitis
.
J Allergy Clin Immunol
.
2018
;
142
(
1
):
139
48.e12
.
37.
Wang
XZ
,
Zhang
HH
,
Qian
YL
,
Tang
LF
.
Sonic hedgehog (Shh) and CC chemokine ligand 2 signaling pathways in asthma
.
J Chin Med Assoc
.
2019
;
82
(
5
):
343
50
.
38.
Oka
A
,
Ninomiya
T
,
Fujiwara
T
,
Takao
S
,
Sato
Y
,
Gion
Y
, et al
.
Serum IgG4 as a biomarker reflecting pathophysiology and post-operative recurrence in chronic rhinosinusitis
.
Allergol Int
.
2020
;
69
(
3
):
417
23
.
39.
Koyama
T
,
Kariya
S
,
Sato
Y
,
Gion
Y
,
Higaki
T
,
Haruna
T
, et al
.
Significance of IgG4-positive cells in severe eosinophilic chronic rhinosinusitis
.
Allergol Int
.
2019
;
68
(
2
):
216
24
.
40.
Brouwer
R
,
Biersteker
K
,
Bongers
P
,
Remijn
B
,
Houthuijs
D
.
Respiratory symptoms, lung function, and IgG4 levels against pig antigens in a sample of Dutch pig farmers
.
Am J Ind Med
.
1986
;
10
(
3
):
283
5
.
41.
Yamashita
N
,
Ito
K
,
Nakagawa
T
,
Haida
M
,
Okudaira
H
,
Nakada
S
, et al
.
IgG and IgE antibodies to Chironomidae in asthmatic patients
.
Clin Exp Immunol
.
1987
;
68
(
1
):
93
9
.
42.
Halpern
GM
,
Scott
JR
.
Non-IgE antibody mediated mechanisms in food allergy
.
Ann Allergy
.
1987
;
58
(
1
):
14
27
.
43.
Kwiatkowski
L
,
Mitchell
J
,
Langland
J
.
Resolution of allergic rhinitis and reactive bronchospasm with supplements and food-specific immunoglobulin G elimination: a case report
.
Altern Ther Health Med
.
2016
;
22
(
S3
):
24
8
.
44.
Qin
L
,
Tang
LF
,
Cheng
L
,
Wang
HY
.
The clinical significance of allergen-specific IgG4 in allergic diseases
.
Front Immunol
.
2022
;
13
:
1032909
.
45.
Yang
BY
,
Yu
HX
,
Yao
W
,
Diao
R
,
Li
BH
,
Wang
YF
, et al
.
Food-specific IgG4-guided diet elimination improves allergy symptoms in children
.
Front Immunol
.
2024
;
15
:
1281741
.
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