{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T03:57:46Z","timestamp":1775447866959,"version":"3.50.1"},"reference-count":28,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"AKKSHI","award":["PKKZH 2024"],"award-info":[{"award-number":["PKKZH 2024"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Chronic Spontaneous Urticaria (CSU) is a skin disorder marked by recurrent wheals and itching, with or without angioedema, which can greatly affect the quality of life. Vitamin D has been implicated in the pathophysiology of various immune-mediated conditions, including CSU. The connection between vitamin D levels, patients\u2019 perceived symptoms, and life impact remains unexplored. This study aims to elucidate vitamin D levels and their correlation with perceived disease-related burden in individuals with CSU. Methods: PROM-based questionnaires, serum 25(OH)D levels, and BMI were statistically analyzed in high-disease-activity CSU, among hospitalized and outpatients who attended the main tertiary hospital center during a 1-year period. These data were compared with a control group, after obtaining their consent. Results: The study included 104 patients, 74 (71.15%) females, mean age 43.17 \u00b1 18.26 years, and 23 controls, 12 (52.17%) females, mean age 44.61 \u00b1 12.77 years. Levels of 25(OH)D were significantly lower in patients compared to controls and in the hospitalized versus the outpatient group (p &lt; 0.05). Suboptimal 25(OH)D was found in 94.23% of patients (mean level 18.29 \u00b1 6.74 ng\/mL) and 82.61% of controls (mean 24.01 \u00b1 7.44 ng\/mL). A BMI &gt; 25 kg\/m2 was found in 71 (68.3%) patients and 11 (47.83%) controls. Age was not significantly correlated with vitamin D levels. A significant positive correlation was found between vitamin D levels and the perceived bothersomeness score of urticarial elements and pruritus. Age was negatively correlated with perceived bothersomeness of pruritus. Irrespective of 25(OH)D levels, perceived bothersomeness of urticarial elements positively correlated with scores for angioedema, pruritus, and the impact of CSU on life and daily activities. Life and daily activities impact scores were also positively correlated with angioedema and pruritus. Conclusions: Suboptimal levels of 25(OH)D were common in CSU patients, especially among hospitalized patients, and were significantly lower compared with controls, suggesting a potential link between low vitamin D status and high disease activity. PROMs did not show a significant association between lower vitamin D levels and worse scores for perceived bothersomeness of urticarial elements, angioedema, pruritus, or impact on life and daily activities.<\/jats:p>","DOI":"10.3390\/jcm15072717","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T02:06:21Z","timestamp":1775441181000},"page":"2717","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Vitamin D and Disease Perception Outcomes in a Cluster of Patients with High-Disease-Activity Chronic Spontaneous Urticaria"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3041-8910","authenticated-orcid":false,"given":"Eralda","family":"Lekli","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, University of Medicine, 1005 Tirana, Albania"},{"name":"Salus Hospital Tirana, 1000 Tirana, Albania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8829-6931","authenticated-orcid":false,"given":"Mehmet","family":"Hoxha","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, University of Medicine, 1005 Tirana, Albania"},{"name":"Service of Allergology, University Hospital Center Mother Teresa, 1005 Tirana, Albania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7655-0696","authenticated-orcid":false,"given":"Maria","family":"Bova","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine 2, Department of Medicine and Medical Specialties, Antonio Cardarelli Hospital, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorian","family":"Shk\u00ebmbi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, University of Medicine, 1005 Tirana, Albania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ester","family":"Ndreu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, University of Medicine, 1005 Tirana, Albania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xheini","family":"Hajrulla","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, University of Medicine, 1005 Tirana, Albania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9033-6568","authenticated-orcid":false,"given":"Elizana","family":"Petrela","sequence":"additional","affiliation":[{"name":"Department of Public Health, Faculty of Medicine, University of Medicine, 1005 Tirana, Albania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8275-2000","authenticated-orcid":false,"given":"Etleva","family":"Qirko","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, University of Medicine, 1005 Tirana, Albania"},{"name":"Service of Allergology, University Hospital Center Mother Teresa, 1005 Tirana, Albania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"ref_1","first-page":"199","article-title":"Vitamin D: Between the brightness of the sun and the darkness of depression","volume":"51","author":"Manzanos","year":"2022","journal-title":"Rev. Colomb. Psiquiatr. (Engl. Ed.)"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1186\/s10020-025-01311-5","article-title":"Vitamin D and skin disorders: Bridging molecular insights to clinical innovations","volume":"31","author":"Li","year":"2025","journal-title":"Mol. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.1038\/s41598-022-05775-x","article-title":"Total and free vitamin D status among apparently healthy adults living in Duhok Governorate","volume":"12","author":"Abdulrahman","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"71","DOI":"10.4274\/tod.94830","article-title":"Pandemic Era: Vitamin D Deficiency and Insufficiency","volume":"20","author":"Fidan","year":"2014","journal-title":"Turk. J. Osteoporos."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s43166-025-00330-8","article-title":"Vitamin D management update: Evidence-based guidelines for vitamin D optimization by the Egyptian Academy for bone and muscle health","volume":"52","author":"Toth","year":"2025","journal-title":"Egypt. Rheumatol. Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1016\/j.jaci.2022.04.010","article-title":"Autoimmune chronic spontaneous urticaria","volume":"149","author":"Kolkhir","year":"2022","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Giannini, S., Giusti, A., Minisola, S., Napoli, N., Passeri, G., Rossini, M., and Sinigaglia, L. (2022). The Immunologic Profile of Vitamin D and Its Role in Different Immune-Mediated Diseases: An Expert Opinion. Nutrients, 14.","DOI":"10.3390\/nu14030473"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"154462","DOI":"10.1016\/j.metabol.2020.154462","article-title":"Reply to Vitamin D deficiency in COVID-19: Mixing up cause and consequence","volume":"115","author":"Chakhtoura","year":"2021","journal-title":"Metabolism"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Jahan-Mihan, A., Stevens, P., Medero-Alfonso, S., Brace, G., Overby, L.K., Berg, K., and Labyak, C. (2024). The Role of Water-Soluble Vitamins and Vitamin D in Prevention and Treatment of Depression and Seasonal Affective Disorder in Adults. Nutrients, 16.","DOI":"10.3390\/nu16121902"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"423","DOI":"10.5021\/ad.2015.27.4.423","article-title":"Vitamin D as a Marker for Disease Severity in Chronic Urticaria and Its Possible Role in Pathogenesis","volume":"27","author":"Woo","year":"2015","journal-title":"Ann. Dermatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s40413-015-0066-z","article-title":"Chronic urticaria merits serum vitamin D evaluation and supplementation; a randomized case control study","volume":"8","author":"Rasool","year":"2015","journal-title":"World Allergy Organ. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"212","DOI":"10.4168\/aair.2017.9.3.212","article-title":"Prevalence and Risk Factors of Urticaria with a Focus on Chronic Urticaria in Children","volume":"9","author":"Lee","year":"2017","journal-title":"Allergy Asthma Immunol. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"106","DOI":"10.4103\/ijd.ijd_634_22","article-title":"The Correlation between Serum Vitamin D and Total IgE Levels and Chronic Spontaneous Urticaria among Chinese Population: A Retrospective Study","volume":"69","author":"Liu","year":"2024","journal-title":"Indian J. Dermatol."},{"key":"ref_14","first-page":"166","article-title":"Is vitamin D concentration an indicator of the severity of atopic dermatitis and chronic spontaneous urticaria in adults?","volume":"48","author":"Jaworek","year":"2020","journal-title":"Pol. Merkur. Lek. Organ Pol. Tow. Lek."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s12948-017-0078-z","article-title":"Amelioration of patients with chronic spontaneous urticaria in treatment with vitamin D supplement","volume":"15","author":"Ariaee","year":"2017","journal-title":"Clin. Mol. Allergy"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"163","DOI":"10.3109\/09546634.2015.1079297","article-title":"Does replacement of vitamin D reduce the symptom scores and improve quality of life in patients with chronic urticaria?","volume":"27","author":"Kocaturk","year":"2016","journal-title":"J. Dermatol. Treat."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1111\/jdv.14548","article-title":"Chronic urticaria and the metabolic syndrome: A cross-sectional community-based study of 11 261 patients","volume":"32","author":"Shalom","year":"2018","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1111\/bjd.14470","article-title":"Epidemiology of chronic spontaneous urticaria: Results from a nationwide, population-based study in Italy","volume":"174","author":"Lapi","year":"2016","journal-title":"Br. J. Dermatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1111\/ced.13368","article-title":"Overweight and obesity may play a role in the pathogenesis of chronic spontaneous urticaria","volume":"43","author":"Kasprzyk","year":"2018","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"156","DOI":"10.2340\/00015555-1443","article-title":"Co-existence of Chronic Urticaria and Metabolic Syndrome: Clinical Implications","volume":"93","author":"Ye","year":"2013","journal-title":"Acta Derm. Venereol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e247","DOI":"10.1111\/jdv.14767","article-title":"Obesity is not associated with severe chronic urticaria in a French cohort","volume":"32","author":"Soria","year":"2018","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.puhe.2020.04.031","article-title":"Does vitamin D deficiency increase the risk of obesity in adults and the elderly? A systematic review of prospective cohort studies","volume":"190","author":"Pereira","year":"2021","journal-title":"Public Health"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Vrani\u0107, L., Mikola\u0161evi\u0107, I., and Mili\u0107, S. (2019). Vitamin D Deficiency: Consequence or Cause of Obesity?. Medicina, 55.","DOI":"10.3390\/medicina55090541"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1007\/s13679-021-00433-1","article-title":"Vitamin D and Obesity: Current Evidence and Controversies","volume":"10","author":"Karampela","year":"2021","journal-title":"Curr. Obes. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1186\/s40001-025-02852-5","article-title":"Chronic urticaria and vitamin D supplementations: A systematic review","volume":"30","author":"Siddiqui","year":"2025","journal-title":"Eur. J. Med. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1007\/s13555-025-01348-8","article-title":"Urticaria Voices: Real-World Experience of Patients Living with Chronic Spontaneous Urticaria","volume":"15","author":"Weller","year":"2025","journal-title":"Dermatol. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1080\/1028415X.2022.2031494","article-title":"Efficacy of B-vitamins and vitamin D therapy in improving depressive and anxiety disorders: A systematic review of randomized controlled trials","volume":"26","author":"Cardoso","year":"2023","journal-title":"Nutr. Neurosci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1001\/jama.2020.10224","article-title":"Effect of Long-term Vitamin D3 Supplementation vs Placebo on Risk of Depression or Clinically Relevant Depressive Symptoms and on Change in Mood Scores: A Randomized Clinical Trial","volume":"324","author":"Okereke","year":"2020","journal-title":"JAMA"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2717\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T02:33:50Z","timestamp":1775442830000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2717"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,3]]},"references-count":28,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15072717"],"URL":"https:\/\/doi.org\/10.3390\/jcm15072717","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,3]]}}}