Background and purpose: There is growing evidence that stress might play a crucial role in the pathogenesis of urticaria. This study examined the association between chronic idiopathic urticaria and stress from major life events and explored the validity of the biopsychosocial model of stress as it relates to urticaria.

Methods: A total of 75 consecutive cases with chronic idiopathic urticaria and 133 controls with tinea pedis who visited a dermatologic clinic for treatment were recruited for participation in this study. Subjects in both groups were assessed with a semi-structured questionnaire to determine the number and subjective weighting of major life events, somatic symptoms, insomnia, irregularity of daily life, perceived family support, ego-function, positive coping, and negative coping. Structural equation modeling was used to examine the influence of biologic, psychologic, and social factors on the development of urticaria. Cluster analysis was used to classify subjects according to risk of developing urticaria.

Results: In the 6 months preceding disease onset, patients with chronic idiopathic urticaria had significantly more life events, higher subjective weighting of impacts from life events, more somatic symptoms, more severe insomnia, less family support, more negative coping tendencies, and were younger in age. Good ego-function, coping strategies and family support were associated with decreased frequency of urticaria.

Conclusions: Stress is an important risk factor for the development of chronic idiopathic urticaria while positive coping tendencies and good family support appear to have preventative effects. Insomnia might be the most important psychosomatic symptom that is a predisposing factor for chronic urticaria.