Table 3.
The Reported Demographic and Clinical Characteristics of Elderly Patients with Chronic Urticaria (CU), and Compared Between the Two Subtypes of CU – Chronic Spontaneous Urticaria and Chronic Inducible Urticaria
| Clinical features: N/Total (%) | CUa | CSU | CIndU |
|---|---|---|---|
| (N=1,112,066) | (N=891) | (N=1,568) | |
| Gender | |||
| Female | 61,170/106,669 (57.4) | 276/432 (63.9) | 873/1,509 (57.9) |
| Age at presentation, mean±SD, years | 70.4±6.2 | 71.6±6.7 | 69.9±3.8 |
| Symptoms | |||
| Wheal alone | 305/413 (73.9) | 236/312 (75.6) | NA |
| Wheal with angioedema | 107/413 (25.9) | 76/312 (24.4) | NA |
| Wheal with anaphylaxis | 1/413 (0.2) | 0/312 (0.0) | 1/1 (100.0) |
| Duration of disease prior diagnosis, mean±SD, years | 1.9±3.6 | 1.9±3.7 | NA |
| Personal history of atopyb | |||
| Allergic rhinitis | 44/233 (18.9) | 9/100 (9.0) | 9/27 (33.3) |
| Asthma | 84,519/982,862 (8.6) | 4/101 (4.0) | 2/27 (7.4) |
| Atopic Dermatitis | 57,163/985,228 (5.8) | 15/162 (9.3) | 4/27 (14.8) |
| Allergic conjunctivitis | 2/73 (2.7) | 0/7 (0.0) | 1/27 (3.7) |
| Unspecified atopy | 18/144 (12.5) | 8/105 (7.6) | 0/1 (0.0) |
| Family history of atopy | |||
| Allergic rhinitis | 5/74 (6.8) | 0/1 (0.0) | 0/2 (0.0) |
| Asthma | 2/74 (2.7) | 0/1 (0.0) | 0/2 (0.0) |
| Atopic Dermatitis | 1/74 (1.4) | 0/1 (0.0) | 0/2 (0.0) |
| Types of chronic inducible urticaria | |||
| Cold urticaria | 18/165 (10.9) | NA | 7/154 (4.6) |
| Symptomatic dermographism | 25/344 (7.3) | NA | 25/344 (7.3) |
| Cholinergic urticaria | 1,468/42,006 (3.5) | NA | 3/124 (2.4) |
| Delayed pressure urticaria | 4/126 (3.2) | NA | 2/124 (1.6) |
| Heat urticaria | 3/154 (2.0) | NA | 2/153 (1.3) |
| Solar urticaria | 2/125 (1.6) | NA | 1/124 (0.8) |
| Aquagenic urticaria | 1/153 (0.7) | NA | 1/153 (0.7) |
| Comorbidityb,c | |||
| Gastrointestinal diseases | 708,417/985,284 (71.9) | 1/5 (20.0) | NA |
| Coronary and other vascular diseases | |||
| Cardiac/cerebral vascular diseases | 72/196 (36.7) | 52/169 (30.8) | 19/26 (73.1) |
| Atrial fibrillation | 1/5 (20.0) | 1/5 (20.0) | NA |
| Metabolic diseases | |||
| Dyslipidemia | 3/7 (42.9) | 2/6 (33.3) | 1/1 (100.0) |
| Hypertension | 183,473/986,035 (18.6) | 103/264 (39.0) | 20/27 (74.1) |
| Obesity | 5/30 (16.7) | 0/4 (0.0) | 5/26 (19.2) |
| Diabetes Mellitus | 34/271 (12.6) | 34/271 (12.6) | NA |
| Unspecified metabolic syndrome | 21/67 (31.3) | 21/67 (31.3) | NA |
| Musculoskeletal diseases | |||
| Osteoporosis | 3/7 (42.9) | 3/7 (42.9) | NA |
| Gout | 1/5 (20.0) | 0/4 (0.0) | NA |
| Avascular hip necrosis | 1/5 (20.0) | 1/5 (20.0) | NA |
| Thyroid diseases | |||
| Hyperthyroidism | 1/1 (100.0) | NA | NA |
| Hypothyroidism | 5/9 (55.6) | 1/5 (20.0) | NA |
| Grave’s disease | 4/9 (44.4) | 2/6 (33.3) | NA |
| Hashimoto’s thyroid diseases | 22/106 (20.8) | 21/105 (20.0) | NA |
| Parathyroid adenoma | 1/5 (20.0) | 1/5 (20.0) | NA |
| Unspecified thyroid diseases | 28/142 (19.7) | 24/116 (20.7) | 4/26 (15.4) |
| Systemic diseases | |||
| Raynaud phenomena | 2/6 (33.3) | 0/4 (0.0) | NA |
| Systemic lupus erythematosus | 1/5 (20.0) | 1/5 (20.0) | NA |
| Anemia | 1/5 (20.0) | 0/4 (0.0) | NA |
| Unspecified autoimmune diseases | 8/70 (11.4) | 8/69 (11.6) | 0/1 (0.0) |
| High myopia | 1/5 (20.0) | 0/4 (0.0) | NA |
| Genitourinary disorders | |||
| Benign prostate hyperplasia | 3/30 (10.0) | 3/30 (10.0) | 3/26 (11.5) |
| Chronic kidney diseases | 6/96 (6.3) | 6/96 (6.3) | NA |
| Chronic obstructive pulmonary diseases | 2/31 (6.5) | 1/5 (20.0) | 1/26 (3.8) |
| Psychiatric problems | |||
| Dementia | 4/67 (6.0) | 4/67 (6.0) | NA |
| Unspecified psychiatric problems | 5/130 (3.9) | 2/103 (1.9) | 2/26 (7.7) |
| Dermatologic diseases | |||
| Psoriasis | 4/96 (4.2) | 4/96 (4.2) | NA |
| Contact dermatitis | 3/96 (3.1) | 3/96 (3.1) | NA |
| Malignancy | |||
| Gastrointestinal cancer | 6/10 (60.0) | 0/4 (0.0) | NA |
| Genitourinary cancer | 2/6 (33.3) | 0/4 (0.0) | NA |
| Bronchioalveolar cancer | 2/6 (33.3) | 0/4 (0.0) | NA |
| Thyroid cancer | 2/6 (33.3) | 2/6 (33.3) | NA |
| Malignant melanoma | 1/5 (20.0) | 0/4 (0.0) | NA |
| Hematologic malignancy | 35/3,625 (1.0) | 0/8 (0.0) | NA |
| Unspecified malignancy | 459/3,714 (12.4) | 11/99 (11.1) | NA |
| Possible causes of urticaria | |||
| Stress | 27/99 (27.3) | 27/99 (27.3) | NA |
| Aspirin intolerance | 8/42 (2.0) | 1/5 (20.0) | 0/4 (0.0) |
| Parasitic infection | 6/129 (4.7) | 0/4 (0.0) | NA |
| Collagen vascular disease | 4/124 (3.2) | NA | NA |
| Insect bite | 3/126 (2.4) | 1/1 (100.0) | 1/27 (3.7) |
| Paronychia | 1/1 (100.0) | NA | NA |
| Unspecified drug allergy | 12/132 (9.1) | 1/8 (12.5) | NA |
| Unspecified food allergy | 1/33 (3.0) | 0/7 (0.0) | 1/26 (3.9) |
| Laboratory investigations | |||
| Positive ASST | 125/263 (47.5) | 107/195 (54.9) | 1/3 (33.3) |
| Positive SPT | 1/9 (11.1) | 0/4 (0.0) | 1/1 (100.0) |
| Positive Basophil histamine release test | 5/13 (38.5) | 4/9 (44.4) | NA |
| Leukocytosis | 4/82 (4.9) | 4/70 (5.7) | 0/1 (0.0) |
| Positive HBsAg | 8/75 (10.7) | 8/68 (11.8) | 0/1 (0.0) |
| Positive anti-HCV | 0/70 (0.0) | 0/68 (0.0) | 0/2 (0.0) |
| Total serum IgE | |||
| Elevated IgE | 8/19 (42.1) | 7/16 (43.8) | 1/1 (100.0) |
| IgE level, mean±SD, kU/L | |||
| ImmunoCAP method (normal range 0–119 kU/L) d | 477.3±288.8 | 477.3±288.8 | NA |
| Pharmacia CAP System IgE FEIA methode (normal range 0–100 kU/L) | 164.9±210.4 | 194.5±269.7 | NA |
| Nephelometry methodf (normal range 0–100 kU/L) | 125 | 125 | NA |
| Elevated erythrocyte sedimentation rate | 22/82 (26.8) | 18/71 (25.4) | 0/1 (0.0) |
| Elevated D-dimer | 2/4 (50.0) | NA | NA |
| Elevated prothrombin fragment | 3/4 (75.0) | NA | NA |
| Abnormal C3 | 0/18 (0.0) | 0/7 (0.0) | 0/1 (0.0) |
| Abnormal C4 | 2/18 (11.1) | 0/7 (0.0) | 0/1 (0.0) |
| Abnormal CH50 | 1/11 (0.0) | 0/5 (0.0) | NA |
| Abnormal C1-INH | 0/13 (0.0) | 0/7 (0.0) | NA |
| Positive antinuclear antibodies | 13/81 (16.0) | 13/69 (18.8) | 0/2 (0.0) |
| Positive anticentromere antibodies | 2/2 (100.0) | NA | NA |
| Positive Anti-FcεRI antibodies | 2/3 (66.7) | 2/3 (66.7) | NA |
| Abnormal free T3 | 0/22 (0.0) | 0/9 (0.0) | 0/1 (0.0) |
| Abnormal free T4 | 4/31 (12.9) | 3/20 (15.0) | 0/1 (0.0) |
| Abnormal TSH | 6/33 (18.2) | 3/19 (15.8) | 0/2 (0.0) |
| Positive antithyroid peroxidase antibodies | 40/150 (26.7) | 25/110 (22.7) | 1/2 (50.0) |
| Positive antithyroglobulin antibodies | 42/124 (33.9) | 31/86 (36.1) | 0/1 (0.0) |
| Abnormal urinalysis | 10/64 (15.6) | 10/63 (15.9) | NA |
| Abnormal stool examination | 6/85 (7.1) | 4/77 (5.2) | NA |
Notes: aIt should be noted that the CU group included all CU patients aged above 60 years. Studies that reported specifically for CSU or CIndU subtypes were also included in the subgroups of CSU and CIndU. bOne patient could have more than one personal history of atopy or one comorbidity. Comorbidity and history of atopy were only showed information from papers which mentioned about each disease. cIt should be noted that the studies of Urbach, Lindelof et al, and Chen et al reported only the number of patients with malignancy, other comorbidities were not identified. dTotal IgE level measured by ImmunoCAP method were reported in three studies, Ban et al (n=37), Romano et al (n=1), and Nettis et al (n=32), which reported about CU, CSU, and CSU, respectively. Referring to the National Center for Health Statistics, Centers for Disease Control and Prevention, the normal range of total IgE based on ImmunoCAP method is 0–119 kU/L. eTotal IgE level measured by Pharmacia CAP method was reported in only one study, Staubach et al (n=4), which reported about CSU. fTotal IgE level measured by Nephelometry method was reported in only one study, Kulthanan et al (n=1), which reported about CSU.
Abbreviations: Anti-FcεRI, anti-FcepsilonRI; ASST, autologous serum skin test; C3, complement C3; C4, complement C4; CH50, total hemolytic complement; C1-INH, complement 1 esterase inhibitor; CIndU, chronic inducible urticaria; CSU, chronic spontaneous urticaria; CU, chronic urticaria; HBsAg, hepatitis B surface antigen; HCV, hepatitis C virus; Ig, immunoglobulin; NA, not available/not applicable; SD, standard deviation; SPT, skin prick test; TSH, thyroid stimulating hormone.