{
  "abstract": "Chronic spontaneous urticaria (CSU) is characterized by the idiopathic appearance of wheals and/or angioedema lasting more than six weeks. There is a critical need to evaluate whether the severity of CSU influences the risk of future immune-mediated comorbidities. We aim to evaluate if patients with moderate-to-severe chronic spontaneous urticaria (CSU) have an increased risk of developing immune-mediated comorbidities compared with matched patients with mild CSU. We conducted a retrospective cohort study using the TriNetX US Collaborative Network database from 2014–2026. We propensity matched patients with ≥2 ICD-10 diagnoses of idiopathic urticaria treated with omalizumab, dupilumab, or cyclosporine (moderate-to-severe disease) to age-, sex-, race-, ethnicity-, comorbidity-, and family history-matched counterparts who were never treated with biologics or cyclosporine (mild disease). After matching, 16,413 patients were included in the moderate-to-severe group, and 16,413 patients were included in the mild group. Patients with moderate-to-severe CSU had a significantly increased risk of developing rheumatoid arthritis OR=1.34 (95% CI: 1.12 to 1.60, p = 0.001) and Sjögren’s syndrome OR=1.04 (1.63–2.56, p < 0.0001), after adjusting for clinical factors and multiple hypothesis testing (Bonferroni’s alpha ≤0.00333). Moderate-to-severe CSU is associated with an increased risk of rheumatoid arthritis and Sjögren’s syndrome compared to mild CSU.",
  "abstract_shown": true,
  "affiliations": [
    "Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America",
    "University of California, Davis School of Medicine, Sacramento, California, United States of America",
    "David Geffen School of Medicine at the University of California, Los Angeles, California, United States of America",
    "USF Morsani College of Medicine, Tampa, Florida, United States of America",
    "University of California, San Diego School of Medicine, San Diego, California, United States of America",
    "Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, United States of America",
    "Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California, United States of America"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Kimberly Smart"
    },
    {
      "affs": [
        1
      ],
      "name": "Andrea Ure"
    },
    {
      "affs": [
        2
      ],
      "name": "Nicole Johnsen"
    },
    {
      "affs": [
        3
      ],
      "name": "Shaliz Aflatooni"
    },
    {
      "affs": [
        4
      ],
      "name": "Julian A. Cortes"
    },
    {
      "affs": [
        5
      ],
      "name": "Gabriela Palma"
    },
    {
      "affs": [
        6
      ],
      "name": "Yvonne Nong"
    },
    {
      "name": "Andrea J. Borba"
    },
    {
      "name": "Paul C. Levins"
    },
    {
      "name": "April W. Armstrong"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/32bzxfwzth42b.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0358883",
  "fulltext_url": null,
  "id": "32bzxfwzth42b",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0358883",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2745|Urticaria and Related Conditions"
    ],
    [
      "plos",
      "/Biology and life sciences/Immunology/Clinical immunology/Autoimmune diseases/Rheumatoid arthritis"
    ],
    [
      "plos",
      "/Biology and life sciences/Immunology/Clinical immunology/Autoimmune diseases/Sjogren syndrome"
    ],
    [
      "plos",
      "/Medicine and health sciences/Clinical medicine/Clinical immunology/Autoimmune diseases/Rheumatoid arthritis"
    ],
    [
      "plos",
      "/Medicine and health sciences/Clinical medicine/Clinical immunology/Autoimmune diseases/Sjogren syndrome"
    ],
    [
      "plos",
      "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Rashes/Urticaria"
    ],
    [
      "plos",
      "/Medicine and health sciences/Dermatology/Skin diseases/Rashes/Urticaria"
    ],
    [
      "plos",
      "/Medicine and health sciences/Epidemiology"
    ],
    [
      "plos",
      "/Medicine and health sciences/Epidemiology/Medical risk factors"
    ],
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      "plos",
      "/Medicine and health sciences/Health care/Health economics/Health insurance"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Socioeconomic aspects of health"
    ],
    [
      "plos",
      "/Medicine and health sciences/Immunology/Clinical immunology/Autoimmune diseases/Rheumatoid arthritis"
    ],
    [
      "plos",
      "/Medicine and health sciences/Immunology/Clinical immunology/Autoimmune diseases/Sjogren syndrome"
    ],
    [
      "plos",
      "/Medicine and health sciences/Medical conditions/Skin diseases/Rashes/Urticaria"
    ],
    [
      "plos",
      "/Medicine and health sciences/Public and occupational health/Socioeconomic aspects of health"
    ],
    [
      "plos",
      "/Medicine and health sciences/Rheumatology/Arthritis/Rheumatoid arthritis"
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    [
      "plos",
      "/Medicine and health sciences/Rheumatology/Sjogren syndrome"
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  "openalex": "W7214119867",
  "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0358883&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-23",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/32bzxfwzth42b.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:43Z",
      "native_id": "10.1371/journal.pone.0358883",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0358883"
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  "subjects": [
    {
      "field": "biology",
      "origin": "plos:immunology",
      "subfield": "immunology"
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    {
      "field": "medicine",
      "origin": "plos:epidemiology",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Moderate-to-severe chronic spontaneous urticaria is associated with increased risk of immune-mediated diseases: A population-based study",
  "title_text": "Moderate-to-severe chronic spontaneous urticaria is associated with increased risk of immune-mediated diseases: A population-based study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:43Z",
  "url": "https://research.draconitic.com/paper/32bzxfwzth42b",
  "venue": "PLOS One",
  "versions": []
}