What causes hormonal urticaria?

Causes of Hormonal Urticaria

Hormonal urticaria is primarily caused by fluctuations in sex hormones that trigger mast cell activation and histamine release, though the exact mechanisms remain unclear in many cases. 1, 2

Hormonal Factors Associated with Urticaria

Sex Hormone Fluctuations

• Menstrual cycle changes: Approximately 29% of female patients experience worsening of urticaria symptoms during the perimenstrual period 3
• Hormonal imbalances: Altered levels of estrogen, progesterone, and androgens can trigger or exacerbate urticaria 2
• Dehydroepiandrosterone sulfate (DHEA-S): Lower serum concentrations have been observed in chronic urticaria patients 2

Specific Hormonal Conditions

• Irregular menstrual cycles: Can be associated with chronic urticaria as demonstrated in case reports 4
• Functional ovarian cysts: May contribute to hormonal imbalances that trigger urticaria 4
• Endocrine disorders: Though conventional reviews mention thyroid disorders as potential causes, clinical evidence is limited 1
• Autoimmune reactions: Hypersensitivity to endogenous female sex hormones has been implicated in some cases 2

Pathophysiological Mechanisms

Immunological Mechanisms

• Mast cell activation: Sex hormones can directly modulate mast cell and basophil function, leading to histamine release 2
• Autoimmune phenomena: Hormonal fluctuations may influence autoimmune processes involved in chronic urticaria 1, 2
• Neuro-endocrine-immune system: Altered function due to stress and hormonal factors has been implicated in urticaria pathogenesis 2

Non-immunological Mechanisms

• Environmental estrogen mimetics: May impact mast cell activation and contribute to urticaria development 2
• Exogenous hormones: Hormonal contraceptives or hormone replacement therapy can either trigger or improve urticaria symptoms depending on the individual 4, 2

Clinical Patterns and Associations

• Gender disparity: Chronic urticaria is approximately twice more frequent in women than in men 2
• Life stages: Puberty, pregnancy, lactation, and menopause generally do not affect urticaria in most patients, contrary to expectations 3
• Thyroid autoimmunity: More prevalent in chronic ordinary urticaria (14%) than in the general population (6%) 1

Diagnostic Considerations

• Targeted investigations: No routine endocrine investigations (including thyroid function tests) are recommended unless additional clinical features suggest an endocrine disorder 1
• Hormonal assessment: Consider evaluating sex hormone levels in cases with clear temporal relationship to menstrual cycle or other hormonal events 2
• Clinical correlation: The diagnosis is primarily clinical, with investigations guided by history rather than performed routinely 1

Treatment Implications

• Hormonal interventions: Oral contraceptives may be effective in cases where hormonal fluctuations clearly trigger urticaria 4
• Standard therapy: Second-generation H1 antihistamines remain the first-line treatment regardless of hormonal triggers 5, 6
• Individualized approach: Treatment should consider the potential hormonal influences on urticaria in specific patients 2

The relationship between hormones and urticaria is complex and often overlooked in clinical practice. While hormonal factors clearly play a role in some patients, particularly women with perimenstrual exacerbations, most hormonal life events do not significantly affect urticaria symptoms in the majority of patients.