{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:05:48Z","timestamp":1790186748621,"version":"4.1.0"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>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\u20132026. We propensity matched patients with \u22652 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\u2009=\u20090.001) and Sj\u00f6gren\u2019s syndrome OR=1.04 (1.63\u20132.56, p\u2009&lt;\u20090.0001), after adjusting for clinical factors and multiple hypothesis testing (Bonferroni\u2019s alpha \u22640.00333). Moderate-to-severe CSU is associated with an increased risk of rheumatoid arthritis and Sj\u00f6gren\u2019s syndrome compared to mild CSU.<\/jats:p>","DOI":"10.1371\/journal.pone.0358883","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:32:06Z","timestamp":1790184726000},"page":"e0358883","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Moderate-to-severe chronic spontaneous urticaria is associated with increased risk of immune-mediated diseases: A population-based study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6686-9971","authenticated-orcid":true,"given":"Kimberly","family":"Smart","sequence":"first","affiliation":[{"name":"University of Southern California","place":["Los Angeles, California, United States of America"],"department":["Keck School of 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America"],"department":["San Diego School of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"Palma","sequence":"additional","affiliation":[{"name":"Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell","place":["Uniondale, New York, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne","family":"Nong","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at the University of California","place":["Los Angeles, California, United States of America"],"department":["Division of Dermatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea J.","family":"Borba","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at the University of California","place":["Los Angeles, California, United States of America"],"department":["Division of 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