Chronic spontaneous urticaria (CSU) is often associated with organ specific autoimmunity but is rarely caused by food allergy. Colourings and preservatives in pre-packaged foods, so called pseudoallergens, have also been implicated. Factors that promote inflammation or reduce anti-inflammatory mechanisms may however, predispose susceptible individuals to CSU. Chronic underlying infection and mental and emotional stress can sometimes precede the onset of CSU and once established can exacerbate the symptoms. There is early evidence of dysbiosis within the gastrointestinal tract in people with CSU and reduced levels of vitamin D are also evident. The latter may be related to the importance of vitamin D3 in increasing T regulatory function which can control a tendency to autoimmunity. It is quite possible that a state of on-going chronic inflammation with reduced anti-oxidant mechanisms may underlie the not infrequent association between CSU and metabolic syndrome. Effective treatment of CSU should involve the use of anti-histamines, intermittent steroids and anti-IgE therapy. For recalcitrant disease immune modulatory therapy has a place. However, talking therapies that reduce stress and anxiety, vitamin D3 supplementation, correction of intestinal dysbiosis and treatment of any chronic infection should also be considered.

中文翻译：

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慢性自发性荨麻疹的压力，拟变应原，自身免疫，感染和炎症

慢性自发性荨麻疹（CSU）通常与器官特异性自身免疫有关，但很少是由食物过敏引起的。还涉及到预包装食品中的色素和防腐剂，即所谓的假性过敏原。但是，促进炎症或降低抗炎机制的因素可能会使易感人群患上CSU。慢性潜在感染以及精神和情绪压力有时可以在CSU发作之前发生，一旦建立就可以加剧症状。有早期证据表明，患有CSU的人胃肠道内有营养不良，维生素D含量降低也很明显。后者可能与维生素D3在提高T调节功能（可控制自身免疫倾向）中的重要性有关。具有降低的抗氧化机制的持续性慢性炎症状态很可能是CSU与代谢综合征之间并非罕见的关联。CSU的有效治疗应包括使用抗组胺药，间歇性类固醇和抗IgE治疗。对于顽固性疾病，免疫调节疗法已占有一席之地。但是，也应考虑采用能减轻压力和焦虑的谈话疗法，补充维生素D3，纠正肠道营养不良和治疗任何慢性感染。