Association Between Proinflammatory Cytokines IL-6 and TNF-Alpha, Psychological Stress and Chronic Spontaneous Urticaria Severity

Introduction: Chronic urticaria (CU), defined as the appearance of wheals/angioedema lasting ≥6 weeks, is often associated with psychological factors like stress. Stress-induced reactions involve the psychological-neuroendocrine-immunological network, which influences disease course/outcome and patient quality of life (QoL). Methods: With 46 participants (23 with CU and 23 healthy controls/HCs), this study examined the association between values of serum proinflammatory cytokines (IL-6 and TNF-α), stress indicators (cortisol levels, perceived stress level), and clinical chronic spontaneous urticaria (CSU) features (CSU severity/UAS, patient QoL). Results: For CSU patients, significantly higher levels of IL-6 (p = 0.002) and TNF-α (p = 0.001) were recorded, as well as higher cortisol levels (p = 0.015) and a lower perception of stress/PSS (p < 0.001), than for HCs. CSU severity linearly and positively correlated with serum cortisol level (r = 0.463; p = 0.463) and impaired QoL (r = 0.715; p < 0.001). Additionally, impaired QoL correlated positively with perceived stress (r = 0.523; p = 0.010) and negatively with age (r = -0.529; p = 0.009). Also, IL-6 levels negatively correlated with perceived stress (r = -0.402; p = 0.006) linearly and moderately. Conclusion: A significant negative correlation between psychological stress and CU indicates the need for a multidisciplinary approach to treatment.