ORIGINAL RESEARCH article
Front. Allergy
Sec. Skin Allergy
Volume 6 - 2025 | doi: 10.3389/falgy.2025.1681375
This article is part of the Research TopicClinical and molecular aspects of managing Chronic Urticaria: Identifying endotypes, phenotypes, and factors determining responses and resistance to treatmentView all 4 articles
Co-existence of Chronic Spontaneous Urticaria with Atopic Dermatitis: Clinical and Immunological perspectives
Provisionally accepted
- 1Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
- 2Order of Sisters of the Holy Family of Nazareth, Rome, Italy
- 3Technion Israel Institute of Technology The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
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Background: Chronic Spontaneous Urticaria (CSU) and Atopic Dermatitis (AD) are both immune-mediated inflammatory skin disorders that often co-exist with other atopic conditions such as asthma and allergic rhinitis. Their shared immunopathological pathways raise the question of a possible interrelationship. Objective: To evaluate the prevalence, clinical features, and immunological profiles of AD in patients with CSU and to explore implications for diagnosis and treatment. Methods: 425 CSU patients treated in Northern Israel between 2021 and 2024, were retrospectively analyzed. Disease activity was assessed using the Urticaria Activity Score-7 (UAS7) and Investigators' Global Assessment (IGA) for AD. The prevalence of asthma, total serum IgE levels, and therapeutic responses were evaluated. Results: Among the 425 CSU patients, 42 (10%) were also diagnosed with AD. Co-morbid patients had a higher frequency of asthma (40%) and high total IgE levels (67%) compared to CSU-only patients. A substantial subset of co-morbid cases required biologic treatments with Dupilumab, offering benefit in AD-dominant cases unresponsive to Omalizumab. Severe CSU was more prevalent in the CSU+AD group (though the prevalence was not statistically significant). Conclusion: CSU and AD frequently co-exist, likely due to overlapping T-cell–mediated immunopathogenic mechanisms. High total IgE and asthma comorbidity may indicate an underlying AD component in CSU patients. Recognition of this overlap is essential for appropriate therapeutic decision-making, including potential escalation to biologic agents targeting T-cell cytokine pathways.
Keywords: CSU, atopic dermatitis, Asthma, Total IgE, anti-TPO
Received: 07 Aug 2025; Accepted: 16 Oct 2025.
Copyright: © 2025 Vadasz, Toubi and Mubariki. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zahava Vadasz, zahava.vadasz@gmail.com
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