Patients With Chronic Urticaria May Face Higher Risk of Metabolic Syndrome

Patients with chronic urticaria have a significantly higher risk of metabolic syndrome, according to a new report. The authors of the report, which was published in Clinical & Experimental Allergy, said their findings should be interpreted as preliminary. However, they added that clinicians may want to consider screening patients with chronic urticaria for metabolic syndrome as a part of their routine care.¹

The authors noted that previous research has suggested there might be a link between chronic urticaria and metabolic syndrome. A review published in 2017 suggested the 2 conditions share similar pathomechanisms, such as a pro-inflammatory state, increased oxidative stress, and alterations in adipokine profile and activation of the coagulation system.² Yet, the authors of that report said more research on the links is needed to understand both the epidemiological links as well as the clinical implications of such links.

In general, the strength of the association between the 2 diseases remains unclear, the authors explained.¹ Gaining a better understanding of any such links is important, they said, since patients with metabolic syndrome require early intervention in order to prevent progression to chronic diseases like cardiovascular disease and type 2 diabetes mellitus.

To better understand the issue, the authors searched a trio of scientific databases to find observational studies evaluating metabolic syndrome in patients with chronic urticaria. They found 227 unique citations. After exclusions, they used 10 of those studies for their analysis. The studies were based on 81,679 patients from 6 countries. The median mean age of patients in the studies was 41.6 years, and two-thirds of participants were women.

Seven of the studies reported data on the association between chronic urticaria and metabolic syndrome. Of those, 5 found that there was a positive association, and one found there was a negative association. The final study found no significant association.

The pooled prevalence of metabolic syndrome among patients with chronic urticaria was 25.2% (95% CI, 19.5-31.8; I² = 92.9%; P < .001). However, they cautioned that differences between the studies and the quality of evidence in the studies meant that their pooled prevalence had low certainty due to a serious risk of bias and serious inconsistency. With similar caveats about low certainty and serious risk of bias and inconsistency, the investigators said the data suggested people with chronic urticaria had an odds ratio of having metabolic syndrome of 1.59 (95% CI, 1.01-2.50, I² = 95.3%, P < .001).

However, the authors noted that the prevalence of metabolic syndrome among people with chronic urticaria was somewhat lower in the 2 studies that had a low risk of bias (13.1%; 95% CI, 8.4-19.7). In addition, the data suggested that metabolic syndrome was less common in patients with chronic urticaria from the Americas.

The study had significant limitations with regard to the availability and quality of the published evidence. Thus, the authors noted their findings ought to be seen as preliminary in nature. While clinicians may want to start screening patients with chronic urticaria for metabolic syndrome, they added that clinicians should also continue to be on the lookout for other common comorbidities in chronic urticaria, including anxiety, depression, and autoimmune thyroiditis.

References

1. Rayner DG, Gou D, Sun W. Prevalence of Metabolic Syndrome in Chronic Urticaria: A Systematic Review and Meta-Analysis. Clin Exp Allergy. Published online July 25, 2025. doi:10.1111/cea.70124

2. Vena GA, Cassano N. The link between chronic spontaneous urticaria and metabolic syndrome. Eur Ann Allergy Clin Immunol. 2017;49(5):208-212. doi:10.23822/EurAnnACI.1764-1489.12