CONTINUOUS PRESSURE URTICARIA AND MENTAL HEALTH: A NARRATIVE REVIEW ON QUALITY OF LIFE AND NEUROIMMUNOLOGICAL INTERACTION

Abstract

Background: Delayed pressure urticaria (DPU) is a subtype of chronic inducible urticaria characterized by painful, deep swelling that develops after sustained mechanical pressure. Although DPU can substantially impair daily functioning and quality of life, its association with psychiatric comorbidities remains less investigated than in chronic spontaneous urticaria (CSU). Objective: To review the available literature on the impact of DPU on mental health and quality of life and to discuss proposed neuroimmune mechanisms linking psychological stress and urticaria. Methods: This structured narrative review searched PubMed/MEDLINE and Google Scholar for studies published between 2010 and 2026 addressing DPU, chronic inducible urticaria, chronic urticaria, anxiety, depression, quality of life, stress, and neuroimmunology. Original studies, systematic reviews, meta-analyses, and international guidelines were considered. The findings were synthesized qualitatively because of the scarcity of DPU-specific studies and the heterogeneity of the available evidence. Results: Chronic urticaria is associated with increased symptoms of anxiety and depression. A systematic review and meta-analysis estimated a pooled prevalence of psychiatric comorbidity of approximately 26.3% in studies without a control group, although estimates vary according to the population, diagnostic criteria, and assessment instruments. Evidence comparing CSU and chronic inducible urticaria is heterogeneous and does not establish that one subtype consistently carries a greater psychiatric burden. In DPU, pain, delayed and unpredictable lesions, functional limitation, and treatment refractoriness may increase psychosocial burden. Neuroimmune mechanisms involving the hypothalamic–pituitary–adrenal axis, neuropeptides, and mast-cell activation have been proposed, but their specific role in DPU remains insufficiently demonstrated. Prospective evidence suggests that omalizumab may improve clinical control in antihistamine-refractory DPU; however, its direct effects on anxiety and depression have not been established. Conclusion: DPU may have a substantial biopsychosocial impact, but direct evidence regarding psychiatric outcomes in DPU remains limited. Future prospective studies should include validated mental-health outcomes and quality-of-life measures as prespecified endpoints. Clinical management should consider the psychological burden of the disease while avoiding unsupported causal assumptions.