Assessment of Metabolic Syndrome in Patients with Chronic Urticaria

Abstract

Urticaria is the most frequent dermatologic disorder seen. It appears as raised, well-circumscribed areas of erythema and edema involving the dermis and are very pruritic.Chronic urticaria is defined as daily or almost daily symptoms lasting for more than 6 weeks. Several studies have analyzed the relationship between other common dermatological conditions like psoriasis, lichen planus or androgenic alopecia and metabolic syndrome, showing a possible association based on a convergent mechanism of T-cell mediated chronic inflammation in cutaneous conditions, atherosclerosis or dyslipidemia. Metabolic Syndrome is interrelated group of metabolic abnormalities, characterized by abdominal obesity, hypertension, impaired lipoprotein metabolism and glucose intolerance. Abdominal obesity is associated with elevated triglycerides (TG) and low high density lipoprotein (HDL) level. The glucose level may be normal early but insulin resistance develops over time and the pancreas fails to secrete insulin and type 2 diabetes develops. Both metabolic syndrome and chronic urticaria share chronic low grade inflammation involving TNF-alpha, CRP and eosinophilic cationic protein (ECP) and may be mutually triggered or exacerbated. Metabolic syndrome is considered a metabolic complication of obesity, adipocyte release inflammatory factors such as; interleukin, TNF-alpha, plasminogen activator inhibitors, free fatty acids, adiponectin, leptin, monocyte chemoattractant protein, these substances promote local and systemic inflammatory and thrombotic state. Furthermore, adipose tissue derived interleukin stimulate CRP production in liver which is an acute phase reactant and a major biomarker of chronic low grade inflammation. The present study aimed to assess the prevalence of metabolic syndrome in chronic urticaria patients compared to their age and sex-matched controls. Metabolic syndrome was higher in patients (26.25%) compared to controls (11.25%) with a statistically significant difference between them. It showed higher prevalence in obese patients than normal BMI and overweight patients. There was a statistically significant difference between patients and controls as regard BMI, Blood pressure and TG, and as regard the mean level of HDL and FBG. There was no statistically significant difference between the two groups as regard LDL and microalbuminuria. There was a positive correlation between CU duration and metabolic syndrome, also its prevalence was higher among CU patients with negative ASST (61.90%) vs. the prevalence of metabolic syndrome among positive ASST (38.09%). From our study we believe that, chronic urticaria patients should be screened for metabolic syndrome criteria for early detection, treatment or even prevention of metabolic syndrome with its sequelae. We believe that one of the limitations in this study is that the study should have been performed on a wide