Chronic urticaria is characterized by mast cells/basophils activation which initiate the inflammatory response. Pathogenetically, the disease may in many cases represent an autoimmune phenomenon. Altered function of the neuro-endocrine-immune system due to stress and other factors has also been implicated its pathogenesis.
Sex hormones modulate immune and inflammatory cell functions, including mast cell secretion, and are regarded as responsible for gender and menstrual cycle phase-associated differential susceptibility and severity of some autoimmune and inflammatory diseases.
Chronic urticaria is approximately twice more frequent in women than in men. In addition,
urticaria may be associated with some diseases and conditions characterized by hormonal changes, including endocrinopathy, menstrual cycle, pregnancy, menopause and hormonal
contraceptives or
hormone replacement therapy.
Hypersensitivity reactions to endogenous or exogenous female
sex hormones have been implicated in the pathogenesis of urticarial lesions associated with
estrogen and
autoimmune progesterone dermatitis. We observed lower serum
dehydroepiandrosterone sulfate (
DHEA-S) concentration in patients with
chronic urticaria with positive and negative response to autologous serum skin test. Thus, the influence of fluctuations in the hormonal milieu and altered
sex hormone expression on the triggering-off, maintenance or aggravation of
urticaria should be taken into account. In addition, the possible impact of
estrogen mimetics, in the environment and in food, on the development of disease associated with mast cell activation must be considered. This review endeavours to outline what is known about the possible influence of
sex hormones in the expression of
urticaria.