Adolescent boys with chronic hives appear to handle stress better than their female counterparts, according to new research. The study, published in Clinical and Translational Allergy, examined 65 adolescents with chronic urticaria and found that disease control is shaped by a combination of immune markers, sex differences, and psychosocial factors.1
Chronic urticaria is characterized by recurrent wheals and itching lasting longer than 6 weeks without an identifiable trigger. Although it is known to impair quality of life and is frequently associated with anxiety and stress, the relationship between psychological coping, immune markers, and disease control remains poorly defined, particularly in pediatric populations.2 To address this gap, researchers conducted a cross-sectional study of adolescents aged 12 to 18 years receiving care at a tertiary pediatric allergy center in Türkiye.
The study included 65 adolescents with chronic urticaria and 65 age-matched healthy controls. Disease activity was measured using the Urticaria Activity Score (UAS) over 7 days, while disease control was assessed using the Urticaria Control Test (UCT). Stress-coping strategies were evaluated using a validated coping strategies scale (SCS) that assesses domains such as resilience, optimism, personal control, and engagement with stressors. Laboratory data, including eosinophil and basophil counts and total immunoglobulin E levels, were collected for patients with urticaria.
The study population had a mean age of 14.86 years, with just over two-thirds being female. Disease control among the group was generally poor, with an average UCT score of 8.785 at their first visit. All patients were taking antihistamines to manage symptoms, and 2 were also receiving omalizumab. About one-third also experienced dermographism, a condition in which the skin develops raised marks from light scratching.
Male patients scored significantly higher than healthy boys on multiple measures of coping ability, including resilience, optimism, and personal control. (P = .039; P = .003; P = .011, respectively). More importantly, these boys also had better control over their hives symptoms, scoring a mean of 10.09 on the UCT compared with a mean score of 8.15 for girls (P = .025).
Despite facing similar levels of disease activity, coping strategies in females with chronic urticaria did not differ from coping strategies in healthy girls. “The higher stress‐coping scores in the male patient group compared to the controls suggest that men are able to develop coping mechanisms for the disease. However, the inability of female patients to do so may be attributed to upbringing, gender roles, and possibly the greater impact of physical appearance and the skin changes caused by urticaria on girls,” the authors suggest.
Investigators also analyzed blood samples and found that higher eosinophil counts were significantly associated with lower UCT scores, indicating poorer disease control rather than increased disease activity. In a regression model, female sex and eosinophil count together accounted for nearly 14% of the variability in urticaria control. Female sex and higher eosinophil counts were associated with a decline in UCT scores. This finding runs counter to what doctors have seen in adult patients, where eosinopenia typically signals more severe disease.3 Among the teens studied, 15.4% had eosinopenia, while basopenia was observed in 27.7%.
In contrast, eosinophil levels were not significantly associated with UAS7 scores. This distinction suggests that eosinophils may be more relevant to long-term disease persistence and control than to daily symptom fluctuations. Lower eosinophil counts and percentages were also associated with longer disease duration, supporting the concept that immune profiles may evolve in adolescents with chronic urticaria. In addition, lower eosinophil counts and percentages correlated with longer time since symptom onset. These cells also showed connections to other immune markers, correlating positively with total IgE levels (r = 0.357) and basophil counts (r = 0.283-0.325).
When investigators examined the association between immune cells and coping, they found that eosinophil levels were negatively correlated with several coping abilities, including struggle, realistic goal setting, and resilience.The authors note that prior studies have proposed mechanisms, such as the recruitment of eosinophils and basophils into the skin during active disease or immune-mediated depletion in the bloodstream, highlighting the complex interaction between immune and psychosocial factors.
The findings suggest that sex differences and immune profiles may help explain why some adolescents experience poorer disease control despite similar symptom severity, and reinforce the importance of assessing both biological and psychosocial factors in chronic urticaria. Although the cross-sectional design limits causal interpretation, the study provides relevant insight into the complexity of chronic urticaria in adolescents.
References
- Sarikavak T, Kaplan Sarikavak S, Çakmak E, Celiksoy MH. Biopsychosocial insights on adolescents with chronic urticaria: the role of eosinophils and stress coping strategies. Clin Transl Allergy. 2025;15(12):e70127. doi:10.1002/clt2.70127
- Cömertoğlu Arslan, Semiha MDa,*; Çelik, Velat MDb. Anxiety depression levels, anxiety sensitivity, and quality of life in children with chronic spontaneous urticaria: A cross-sectional study. Medicine. 2024;103(47):p e40603. doi:10.1097/MD.0000000000040603
- Kolkhir P, Church MK, Altrichter S, et al. Eosinopenia, in chronic spontaneous urticaria, is Associated with high disease activity, autoimmunity, and poor response to treatment. J Allergy Clin Immunol Pract. 2020;8(1):318-325.e5. doi: 10.1016/j.jaip.2019.08.025
