Study Links Chronic Spontaneous Urticaria to Increased Mortality Risk
Chronic spontaneous urticaria (CSU), traditionally considered a non–life-threatening condition, was associated with significantly increased all-cause mortality and higher rates of several major causes of death in a large retrospective cohort study of U.S. electronic health records.
Investigators analyzed data from the TriNetX network, including 272,190 adults with CSU and more than 12.7 million controls without urticaria. After propensity score matching, the final analysis included 264,680 patients with CSU and an equal number of matched controls. The mean age of patients with CSU was 47.5 years, and 71.5% were female.
Compared with matched controls, patients with CSU experienced significantly higher all-cause mortality at multiple time points. Mortality risk was elevated at 3 months (hazard ratio [HR], 2.10; 95% CI, 1.97-2.22), 1 year (HR, 1.77; 95% CI, 1.71-1.83), and 5 years (HR, 1.69; 95% CI, 1.65-1.73), with all comparisons reaching statistical significance (P < .0001).
The study also identified increased risks for several major contributors to mortality. Notably, patients with CSU had more than a threefold higher risk of suicidal ideation or suicide attempts compared with controls (HR, 3.14; 95% CI, 3.00-3.28). Risk for malignant neoplasms was also elevated (HR, 2.09; 95% CI, 2.02-2.16).
According to the authors, “CSU is associated with increased mortality likely due to comorbidities, especially suicide.” The association appeared particularly pronounced among White patients and younger individuals with CSU.
Treatment status was also associated with differences in mortality outcomes. Five-year all-cause mortality rates were lower among patients treated with second-generation H1 antihistamines than among untreated patients (1.0% vs 2.3%; HR, 1.84; P < .0001). Mortality rates were lower still among patients treated with omalizumab compared with those receiving antihistamines alone (0.7% vs 2.6%; HR, 3.99; P = .0003).
Reference
Kolkhir P, Bieber K, Hawro T, et al. Mortality in adult patients with chronic spontaneous urticaria: A real-world cohort study. J Allergy Clin Immunol. 2025;155(4):1290-1298. doi:10.1016/j.jaci.2024.11.036
