URTICARIA ASSOCIATED WITH SYSTEMIC-DISEASE AND PSYCHOLOGICAL-FACTORS

Chronic ''idiopathic'' urticaria, diagnosed by excluding the most freq uent causes of acute recurrent urticaria, such as IgE-mediated disease and drug exposure (nonsteroidal anti-inflammatory drugs [NSAIDs] and opiates), may be caused by an underlying systemic illness. in this art icle, we examine various diseases that have been implicated as causati ve factors in chronic urticaria. The most common pathologic finding in ''idiopathic'' urticaria appears to be a histamine-releasing autoanti body that binds the IgE receptor present on mast cells and basophils. Rarely, other autoimmune illnesses such as systemic lupus erythematosu s or immune complex disease may be implicated as causative factors, pa rticularly when biopsy specimens of the urticarial lesion reveal a vas culitic histopathology. Although less well documented, several types o f infection and malignancy are discussed that have occasionally been a ssociated with chronic urticaria. Also, several unusual hereditary syn dromes in which urticaria is a commonly observed feature are described . Finally the possible contributions of psychological factors to the m orbidity of chronic urticaria are presented to call attention to the h igh incidence of depressive symptoms and anxiety among persons who suf fer from this often debilitating disease.