{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T11:59:25Z","timestamp":1790683165330,"version":"4.1.0"},"reference-count":66,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Experimental Dermatology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Chronic spontaneous urticaria (CSU) is a mast cell\u2010driven inflammatory disease frequently accompanied by anxiety, depression, sleep disturbance, fatigue, and impaired quality of life. Pruritus, disturbed sleep, psychosocial burden, and treatment\u2010related effects are established contributors to this neuropsychiatric and functional burden. Whether immune\u2010to\u2010brain signalling provides an additional mechanism in a susceptible subgroup remains unknown. This hypothesis\u2010driven narrative review examines the blood\u2013brain barrier (BBB) as one potential interface linking CSU\u2010associated inflammation to central effects. CSU studies report systemic inflammatory, vascular, and neuroimmune signals, including cytokine signatures, circulating matrix metalloproteinase\u20109, and substance P\u2013MRGPRX2\u2010related findings. Their potential neurovascular relevance is inferred from experimental or other disease settings rather than demonstrated in CSU per se. Our targeted search identified no human CSU studies assessing regional BBB permeability with dynamic contrast\u2010enhanced magnetic resonance imaging or tracer methods, blood\u2013cerebrospinal fluid barrier function with the albumin quotient, serum S100B, or brain endothelial tight\u2010junction integrity, including claudin\u20105 or occludin. Structural and functional neuroimaging findings in CSU do not establish barrier dysfunction. Systemic mastocytosis provides comparative evidence for mast\u2010cell\u2010related neuropsychiatric manifestations, although barrier involvement remains unproven. We therefore propose neurovascular alteration as a testable, non\u2010exclusive risk modifier whose relevance to CSU pathophysiology and psychiatric symptoms remains to be established.<\/jats:p>","DOI":"10.1111\/exd.70369","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T11:19:35Z","timestamp":1790680775000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Chronic Spontaneous Urticaria and Psychiatric Symptoms: The Blood\u2013Brain Barrier Hypothesis"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0303-1633","authenticated-orcid":false,"given":"Gerasimos N.","family":"Konstantinou","sequence":"first","affiliation":[{"name":"Department of Psychiatry University of Toronto  Toronto Ontario Canada"},{"name":"Centre for Addiction and Mental Health (CAMH)  Toronto Ontario Canada"},{"name":"Temerty Centre for Therapeutic Brain Intervention CAMH  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