O estresse diante da pandemia de COVID-19 como fator exacerbador da urticária
Stress during the COVID-19 pandemic as an exacerbating factor for urticaria
Paula Natassya Argolo; Grazielly Fatima Pereira; Antônio Abilio Motta; Jorge Kalil; Rosana Câmara Agondi
Resumo
Introdução: Os sintomas gerados pela urticária crônica (UC) afetam significativamente a qualidade de vida dos pacientes, e o estresse pode ser um fator de exacerbação. Isso se torna ainda mais importante no atual cenário de pandemia da doença causada pelo coronavírus (COVID-19). Diante da impossibilidade de manter a mesma quantidade de consultas presenciais, surgiu a necessidade de saber como estariam os pacientes com UC: se apresentariam exacerbação da doença de base caso se infectassem com o SARS-CoV-2, se a UC predisporia os pacientes a um quadro mais grave de COVID-19, e se o estresse emocional a que os pacientes estariam sujeitos exacerbaria sua doença de base. Métodos: Trata-se de um estudo observacional retrospectivo com dados coletados através do registro das informações coletadas de pacientes com UC durante remarcação de suas consultas, através de ligações telefônicas. Resultados: Foram incluídos 140 pacientes no estudo, no período de 29/04/2020 a 15/07/2020. O estresse emocional estava presente em 80 pacientes (57,1%), sendo que destes, 30% relataram piora da urticária. A obesidade foi a outra comorbidade mais relatada pelos pacientes com UC (35%). Dos 22 pacientes que procuraram o Pronto-Socorro, 9 (40,9%) foram investigados. Destes, 5 (55,6%) realizaram investigação específica para COVID-19. Conclusões: Durante a pandemia da COVID-19, os nossos pacientes com UC se encontraram mais estressados emocionalmente, e isso foi um fator associado à piora da urticária. A obesidade, no nosso grupo de pacientes, foi muito prevalente.
Palavras-chave
Abstract
Introduction: Chronic urticaria (CU) symptoms significantly affect patient quality of life, and stress can be an exacerbating factor. This becomes even more important in the current pandemic setting of the novel coronavirus disease 2019 (COVID-19). Given the impossibility of maintaining the same schedule of in-person medical appointments, there was a need to know how patients with CU would behave: if they would have an exacerbation of the underlying disease if they became infected with SARS-CoV-2, if CU would predispose patients to a more severe form of COVID19, and if emotional stress would exacerbate their underlying disease. Methods: This is a retrospective observational study of data collected from records of patients with CU when their medical appointments were rescheduled via telephone call. Results: One hundred and forty patients were included in the study from 4/29/2020 to 7/15/2020. Stress was present in 80 patients (57.1%), of which 30% reported worsening of urticaria. Obesity was the most reported comorbidity in patients with CU (35%). Of the 22 patients who sought emergency care, 9 (40.9%) were investigated. Of these, 5 (55.6%) underwent specific investigation for COVID-19. Conclusions: During the COVID-19 pandemic, our CU patients were found to be more emotionally stressed, and this factor was associated with worsening of urticaria. Obesity, in our group of patients, was very prevalent.
Keywords
Referências
1. WHO. Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020 [site na Internet]. Disponível em: https://www.who.int/dg/speeches/detail/who-director-general-sopening-remarks-at-the-media-briefing-on-covid-19–11-march2020. Acessado em: 10/07/2020.
2. Ridolo E, Pucciarini F, Barone A, Nouvenne A, Meschi T, Peveri S, et al. Dermatological manifestations during COVID-19 infection: a case series and discussion on the problem of differential diagnosis. Acta Biomed. 2021 Feb 9;92(1):e2021103. doi: 10.23750/abm.v92i1.11236. PMID: 33682815.
3. Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol. 2020;34:e212-3.
4. Wedi B, Raap U, Wieczorek D, Kapp A. Urticaria and infections. Allergy Asthma Clin Immunol. 2009;5:10.
5. Imbalzano E, Casciaro M, Quartuccio S, Minciullo PL, Cascio A, Calapai G, et al. Association between urticaria and virus infections: A systematic review. Allergy Asthma Proc. 2016;37:18-22.
6. Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, BallmerWeber B, et al. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018;73:1393-414.
7. Gonzalez-Diaz SN, Martin B, Villarreal-Gonzalez RV, Lira-Quezada CE, Macouzet-Sanchez C, Weinmann AM, et al. Physiological impacto f the COVID-19 pandemic on patients with allergic diseases. World Allergy Organ J. 2021;14:100510-.
8. Konstantinou GN, Konstantinou GN. Psychiatric comorbidity in chronic urticaria patients: a systematic review and meta-analysis. Clin Transl Allergy. 2019;9:42.
9. Choi WS, Lim ES, Ban GY, Kim JH, Shin YS, Park HS, et al. Diseasespecific impairment of the quality of life in adult patients with chronic spontaneous urticaria. Korean J Intern Med. 2018;33:185-92.
10. Dias GAC, Pires GV, Valle SOR, Dortas Júnior SD, Levy S, França AT, et al. Impact of chronic urticaria on the quality of life of patients followed up at a university hospital. An Bras Dermatol. 2016;91:754-9.
11. Maurer M, Ortonne JP, Zuberbier T. Chronic urticaria: a patient survey on quality-of-life, treatment usage and doctor–patient relation. Allergy. 2009;64:581-8.
12. Sanchez-Borges M, Caballero-Fonseca F, Capriles-Hulett A, Gozález-Aveledo L, Maurer M. Factors linked to disease severity and time to remission in patients with chronic spontaneous urticaria. J Eur Acad Dermatol Venereol. 2017;31:964-71.
13. Curto-Barredo L, Archilla LR, Vives GR, Pujol RM, Giménez-Arnau AM. Clinical features of chronic spontaneous urticaria that predict disease prognosis and refractoriness to standard treatment. Acta Derm Venereol. 2018;98:641-7.
14. Pondeljak N, Lugovic-Mihic L. Stress-induced interaction of skin immune cells, hormones, and neurotransmitters. Clin Ther. 2020;42:757-70.
15. Ograczyk-Piotrowska A, Gerlicz-Kowalczuk Z, Pietrzak A, ZalewskaJanowska AM. Stress, itch and quality of life in chronic urticaria females. Postepy Dermatol Alergol. 2018;35:156-60.
16. Chung MC, Symons C, Gilliam J, Kaminski ER. Posttraumatic stress disorder, emotional supression and psychiatric co-morbidity in patients with chronic idiopathic urticaria: a moderated mediation analysis. J Mental Health. 2018;27:442-9.
17. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5.
18. Costa FF, Rosário WR, Ribeiro Farias AC, de Souza RG, Duarte Gondim RS, Barroso WA. Metabolic syndrome and COVID-19: An update on the associated comorbidities and proposed therapies. Diabetes Metab Syndr. 2020;14:809-14.
19. Araújo AMFS, Cosentino JBM, Kalil J, Motta AA, Agondi RC. Influência do estresse emocional na apresentação clínica do paciente com urticária crônica. Arq Asma Alerg Imunol. 2018;2(Supl 1):S141.
20. Zuberbier T, Balke M, Worm M, Edenharter G, Maurer M. Epidemiology of urticaria: a representative cross-sectional population survey. Clin Exp Dermatol. 2010;35:869-73.
21. Vena GA, Cassano N. The link between chronic spontaneous urticaria and metabolic syndrome. Eur Ann Allergy Clin Immunol. 2017;49:208-12.
22. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020 Mar 17;323(11):1061-9. doi: 10.1001/jama.2020.1585.
23. Ministério da Saúde. www.saude.gov [site na Internet]. Acessado em: 10/07/2020.
24. Rezende LFM, Thome B, Schveitzer MC, Souza-Júnior PRB, Szwarcwald CL. Adults at high-risk of severe coronavirus disease2019 (COVID-19) in Brazil. Rev Saude Publica. 2020;54:50.
25 Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. Zhonghua Liu Xing Bing Xue Za Zhi. 2020 Feb 10;41(2):145-51. Chinese. doi: 10.3760/cma.j.issn.0254-6450.2020.02.003.
Submetido em:
15/03/2021
Aceito em:
22/03/2021
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email