Chronic urticaria can be caused by cancer and resolves with its cure

Abstract

We present 26 cases (ours and 25 from an extended literature review) in which chronic spontaneous urticaria (CSU) seems to be caused by a malignancy (mostly carcinoma or hematologic malignancy): the CSU precedes the neoplasia diagnosis by some months (2-8mo in 80%) and resolved days after chemotherapy/ surgical resection of the malignancy. In three patients, the urticaria flare-up alerted the treating physician of neoplasia recurrence. There could be publication bias, but the narrow time-span between cancer remission and urticaria resolution and especially the recurrence of urticaria that led to detection of cancer relapse in some of our cases are arguments in favor of a causal relationship. Physicians treating CSU should be aware of this. As in all CSU, complete blood count, C reactive protein and erythrocyte sedimentation rate should form part of the initial work-up. As age-indicated screening, over 45 years, a mastography/prostate antigen test should be taken and in recalcitrant, treatment-resistant CSU i.a. a thyroid gland ultrasound could be considered to rule out the most frequently associated malignancies.

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