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Urticaria is a vascular reaction of the skin marked by the transient appearance of smooth, slightly elevated erythematous papules or plaques (wheals) and often accompanied by severe pruritus.1 The triggers of urticaria are unknown in around half of all cases.1 One of the identified triggers is allergic reactions towards food and/or environmental factors such as pollen and dust mites. This reaction is commonly based on type I hypersensitivity reaction. Most cases of urticaria are self-limited and of short duration.2 Almost 90% of the population has experienced urticaria with or without pruritus.2 The pathogenesis of chronic urticaria (CU) is not completely understood. However, mast cell degranulation and histamine release are thought to play a central role. Chronic idiopathic urticaria (CIU) is the most common type of chronic urticaria. In 7 out of 10 cases of CU, the cause or trigger cannot be identified; therefore, it is diagnosed as CIU. In patients with CIU, there are no specific triggers or any other causes that activate the mast cells can be identified.1-3 Acute urticaria is defined as the presence of evanescent wheals which completely resolve within six weeks while chronic urticaria is defined as the presence of evanescent wheals which persist for more than six weeks.3 An urticaria that is recurrent and lasts more than 6 weeks is categorized as chronic urticaria, and if the triggering factor cannot be identified, it is considered as a chronic idiopathic urticaria.3-5 In CIU, the cause is generally difficult to identify and it is often recurrent, hence it will lower the patients’ quality of life. Many factors are related to CIU; including drugs, foods, infections, systemic diseases, inhalant allergens, contact allergens, insects bites, physical agents, psychological stress, and genetic factors.6 Those factors induce urticaria through either immunologic or non immunologic mechanism. The immunopathogenesis of urticaria is type I hypersensitivity reaction, where allergen (antigen) which enters the body will attach to immunoglobulin E (IgE) on the surface of mast cell through a specific receptor which will trigger the mast cell degranulation and release various inflammatory mediators.6,7 There are two types of mediators released; preformed (secretory granule-associated) and newly synthesized mediators after cellular activation including the ABSTRACT

The effect of psychological stress on c-reactive protein and peripheral blood cells count in chronic idiopathic urticaria