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Comorbidity of chronic spontaneous urticaria and autoimmune thyroid diseases: A systematic review
Author(s) -
Kolkhir P.,
Metz M.,
Altrichter S.,
Maurer M.
Publication year - 2017
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.13182
Subject(s) - medicine , autoimmunity , thyroid , thyroid disease , thyroiditis , immunology , thyroid peroxidase , autoantibody , levothyroxine , disease , endocrinology , antibody
Patients with chronic spontaneous urticaria ( CSU ) are widely held to often have other autoimmune disorders, including autoimmune thyroid disease. Here, we systematically evaluated the literature on the prevalence of thyroid autoimmunity in CSU and vice versa. There is a strong link between CSU and elevated levels of IgG antithyroid autoantibodies ( AA bs), with most of a large number of studies reporting rates of ≥10%. Levels of IgG against thyroid peroxidase ( TPO ) are more often elevated in CSU than those of other IgG antithyroid AA bs (strong evidence). Levels of IgG antithyroid AA bs are more often elevated in adult patients with CSU than in children (strong evidence). Patients with CSU exhibit significantly higher levels of IgG antithyroid AA bs (strong evidence) and IgE‐anti‐ TPO (weak evidence) than controls. Elevated IgG antithyroid AA bs in CSU are linked to the use of glucocorticoids (weak evidence) but not to disease duration or severity/activity, gender, age, or ASST response (inconsistent evidence). Thyroid dysfunction rates are increased in patients with CSU (strong evidence). Hypothyroidism and Hashimoto's thyroiditis are more common than hyperthyroidism and Graves’ disease (strong evidence). Thyroid dysfunction is more common in adult patients with CSU than in children (strong evidence) and in female than in male patients with CSU (weak evidence). Urticaria including CSU is more prevalent in patients with thyroid autoimmunity than in controls (weak evidence). CSU can improve in response to treatment with levothyroxine or other thyroid drugs (strong evidence). Pathogenic mechanisms in CSU patients with thyroid autoimmunity may include IgE against autoantigens, immune complexes, and complement.