Biological origins, but not only: a guide to a condition with no defined cause

Inflammation, feminine singular. Behind this dictionary definition, there is always a whole world to explore. Indeed, there exists a realm of subtle differences that make the body’s inflammatory processes distinct from one another; they can cause them to flare up and subside, and they highlight ‘dangerous’ connections between organs that appear to be unrelated. All these realities – albeit with varying clinical characteristics and impact from person to person – also characterise chronic spontaneous urticaria, the wheals that define it, and the duration and intermittent nature of the skin symptoms and general problems. An interesting contribution by Rohit D. Divekar, of the Mayo Clinic in Rochester, attempts to map out the inflammatory processes underlying the condition; on the web, he has drawn up a sort of ‘guide’ for patients, starting from a single piece of data. In most cases, chronic spontaneous urticaria has no clearly defined cause. It therefore often makes little sense to look for a possible trigger in everyday life, such as in food or the environment. According to the expert, in fact, the condition is linked to “alterations in the immune system that can develop spontaneously and without any specific trigger”, as Divekar himself explains on the clinic’s website.

Trying to understand what happens, therefore, remains a challenge. Indeed, given the complexity of the immune system, there are many different cell types and molecules involved in the development of the condition. It has, however, been observed that certain immune cells – ranging from mast cells to eosinophils, basophils and lymphocytes (essentially different families of white blood cells) – tend to become overactive when illness strikes. Their hyperactivity leads to the release of a series of inflammatory molecules that permeate the body, as well as substances such as cytokines, which ultimately play a part in causing urticaria and other conditions. Reducing the entire process to a simple biological cascade – the innermost and immunologically hidden mechanisms of which, moreover, have yet to be fully elucidated – is, however, an oversimplification. One need only consider, for example, the presence of psycho-emotional conditions that, in some way, trigger skin reactions more readily: as noted in the document available on the Mayo Clinic website, stress can play an important role, just as there appear to be gender- and age-related factors that make women aged between 20 and 40 the group most likely to develop the condition.

However, when considering the possible ‘links’ between medical conditions, there are other conditions that need to be taken into account, forming a sort of ‘continuum’ that has yet to be fully assessed. This is the conclusion drawn from the findings of a study published in *Allergy* and conducted by Philip Curman, Diamant Thacj and Ralf J. Ludwig of the University of Lübeck. According to the study, systemic inflammation may underlie a potentially increased risk of arrhythmias and other cardiovascular events in those suffering from chronic spontaneous urticaria, making it necessary to carry out preventive assessments of the circulatory system in people with this skin condition. “Inflammation is re-emerging as one of the main pathogenic mechanisms underlying numerous cardiovascular diseases,” notes Leonardo De Luca, Head of Cardiology at the Policlinico San Matteo in Pavia. “There is growing evidence that conditions apparently limited to a single organ, such as chronic spontaneous urticaria, may reflect a systemic inflammatory state with repercussions on the heart and blood vessels as well.” Finally, to bring things full circle, it is important to bear in mind the extent to which, and the ways in which, chronic spontaneous urticaria may be more readily associated with autoimmune disorders. Would you like an example of what happens? Consider how autoimmune thyroid inflammation – Hashimoto’s thyroiditis – might come into play. And that is just one example!