Background. Chronic spontaneous urticaria (CSU) is autoimmune in nature and associated with thyroid autoimmunity (TA), but\nevidence on autoimmunity in relation to CSU progression and prognosis is limited.We evaluated whether TA and autoimmunity\nin CSU are correlated with disease severity, therapeutic response, and time to remission and establish an association between\nCSU characteristics linked to thyroid autoantibody. Methods. Medical records of patients diagnosed with urticaria attending\noutpatient dermatology clinic at a university-based hospital from 2013 to 2017 were retrospectively reviewed. Data on the clinical\ncharacteristics, laboratory investigations particularly thyroid antibody titers, autologous serum skin test (ASST) and autologous\nplasma skin test (APST) results and their link to disease severity, treatments, and time to remission of CSU patientswere analyzed.\nResults. Of 1,096 patients with urticaria, 60.2% had CSU. Three-hundred patients fulfilled the inclusion criteria for CSU with\ncomplete thyroid antibody testing. Positive TA was significantly associated with female gender and age > 35 years (p = 0.008).\nAntithyroid peroxidase (anti-TPO)-positive patients suffered from CSU longer than 12 and 18 months compared to anti-TPOnegative\npatients (100.0% vs. 82.6%, p = 0.042, and 100.0% vs. 75.9% p = 0.020, respectively). The presence of urticarial attacks > 4\ndays/week was significantly seen in ASST and APST-positive patients compared to those without (84.6% vs. 61.3%, p = 0.011, and\n85.3% vs. 61.8%, p = 0.006, respectively). Positive APST patients were more difficult to treat than those with negative results (61.2%\nvs. 37.8%, p = 0.017). Conclusions. Antithyroid peroxidase is a predictor of time to remission, while autologous skin testing is linked\nto disease severity (ASST and APST) and therapeutic response (APST) in CSU patients.
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