{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T16:56:37Z","timestamp":1788886597805,"version":"build-2803163510"},"reference-count":58,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T00:00:00Z","timestamp":1761350400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Chronic urticaria (CU), defined as the appearance of wheals\/angioedema lasting \u22656 weeks, is often associated with psychological factors like stress. Stress-induced reactions involve the psychological\u2013neuroendocrine\u2013immunological network, which influences disease course\/outcome and patient quality of life (QoL). With 46 participants (23 with CU and 23 healthy controls\/HCs), this research examined the relationship between values of serum proinflammatory cytokines (IL-6 and TNF-\u03b1), stress indicators (cortisol levels, perceived stress level), and clinical chronic spontaneous urticaria (CSU) features (CSU severity\/UAS, patient QoL). For CSU patients, significantly higher levels of IL-6 (p = 0.002) and TNF-\u03b1 (p = 0.001) were recorded, as well as higher cortisol levels (p = 0.015) and a lower perception of stress\/PSS (p &lt; 0.001) than for HCs. CSU severity linearly and positively correlated with serum cortisol level (r = 0.463; p = 0.463) and impaired QoL (r = 0.715; p &lt; 0.001). Additionally, impaired QoL correlated positively with perceived stress (r = 0.523; p = 0.010) and negatively with age (r = \u22120.529; p = 0.009). Also, IL-6 levels negatively correlated with perceived stress (r = \u22120.402; p = 0.006) linearly and moderately. The significant negative correlation between psychological stress and CU indicates that a comprehensive approach to treatment is necessary.<\/jats:p>","DOI":"10.3390\/ijms262110384","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:51:42Z","timestamp":1761526302000},"page":"10384","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Association Between Proinflammatory Cytokines IL-6 and TNF-Alpha, Psychological Stress and Chronic Spontaneous Urticaria Severity"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7494-5742","authenticated-orcid":false,"given":"Liborija","family":"Lugovi\u0107-Mihi\u0107","sequence":"first","affiliation":[{"name":"School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia"},{"name":"Department of Dermatovenereology, University Hospital Center \u201cSestre Milosrdnice\u201d, Vinogradska cesta 29, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5379-9846","authenticated-orcid":false,"given":"Maja","family":"\u0160trajtenberger","sequence":"additional","affiliation":[{"name":"Department of Pulmology, Special Hospital for Pulmonary Diseases, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9932-5558","authenticated-orcid":false,"given":"Matea","family":"Kuna","sequence":"additional","affiliation":[{"name":"School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia"},{"name":"Department of Dermatovenereology, University Hospital Center \u201cSestre Milosrdnice\u201d, Vinogradska cesta 29, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bla\u017eenka","family":"Ladika-Davidovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Oncology and Nuclear Medicine, University Hospital Center \u201cSestre Milosrdnice\u201d, Vinogradska 29, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ema","family":"Barac","sequence":"additional","affiliation":[{"name":"Family Physician Office, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5357-5890","authenticated-orcid":false,"given":"Maja","family":"Vilibi\u0107","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University Hospital Center \u201cSestre Milosrdnice\u201d, 10000 Zagreb, Croatia"},{"name":"School of Medicine, Catholic University of Croatia, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1111\/all.15090","article-title":"The International EAACI\/GA2LEN\/EuroGuiDerm\/APAAACI Guideline for The Definition, Classification, Diagnosis, and Management of Urticaria","volume":"77","author":"Zuberbier","year":"2022","journal-title":"Allergy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.iac.2024.03.004","article-title":"Chronic Spontaneous Urticaria: Quality of Life and Economic Impacts","volume":"44","author":"Keller","year":"2024","journal-title":"Immunol. 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