With CSU, we have to be careful not to suggest that a comorbid disease is the cause. Because CSU can be a disease of type 2 inflammation, we can see other type 2 comorbidities in patients with CSU, such as atopic dermatitis.

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In individuals with CSU, there can be common parallel immunologic threads driving multiple diseases. Autoimmune conditions may also be present as comorbidities in patients with CSU. For example, systemic lupus erythematosus can occur along with CSU. Additionally, one of the most common autoimmune comorbidities of CSU is autoimmune thyroiditis. These kinds of autoimmune diseases can run together. If you have one, you can have some others as well.

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Then there are secondary comorbid medical issues that directly result from the impact of the disease. For instance, the impact of CSU on patient quality of life can lead to depression, and sleep disturbances due to the impact of CSU could lead to injuries from a patient not paying attention, tripping, or a car accident. However—and to be crystal clear—these are not “root causes” of CSU.

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Emotional factors can be associated with disease persistence. On average, CSU lasts 5 to 7 years, and there are some patients who have it for much longer. In a study by Memet et al, it was found that CSU disease activity can affect depression severity. Moreover, the effects of CSU on quality of life can definitely be associated with depression. Finally, that depression could then perpetuate disease also, which then feeds more depression, which then becomes circular.

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In patients with CSU, a lack of innovation, access to care, and even quality care has probably added to the comorbidities that I have discussed. With the help of medications that take the whole picture into account, we now have an opportunity to really change the course for both patients who have had CSU for a while and those who have just been diagnosed.