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Exaggerated neurophysiological responses to stressor in patients with chronic spontaneous urticaria

Chronic spontaneous urticaria (CSU) has detrimental effects on patients' quality of life (QoL) and emotional well-being.1 Patients with CSU have increased levels of emotional distress, anxiety, depression, somatoform disorders, and their elevated stress correlates with CSU activity.2,3 Mechanisms of stress-induced CSU exacerbation suggest that patients with CSU may be vulnerable to stressors and have altered and exaggerated stress responses. This may trigger the secretion of neuropeptides from sensory skin nerves4 that, in turn, interact with mast cells and prime them for degranulation and the release of histamine, and result in CSU attacks.5 Furthermore, stress levels assessed with the Perceived Stress Scale (PSS) were shown to significantly correlate with urticaria activity and control.6 Stress has become an integral part of the western lifestyle, emphasizing the need to illuminate its role in CSU.