Response of Urticaria to Stress Intervention

As many patients with chronic urticaria display heightened levels of stress before and/or
after the onset of the urticaria, the purpose of this study is to evaluate the effect of
psychological stress intervention on chronic urticaria. Intervention group participants will
meet with a psychiatry resident once a week for six consecutive weeks to be educated on
psychological stress intervention techniques. Control group participants will meet with a
psychiatry resident once a week for six consecutive weeks for general supportive therapy,
which will not provide psychological stress intervention. All participants will complete a
packet of psychological and dermatological questionnaires before the first session with the
psychiatry resident and one week after the final session. All participants will record daily
1) their urticaria symptoms and 2) the type and number of antihistamines taken. Blood and
saliva samples will be collected before the first session and one week after completion of
the final session to compare the levels of stress hormones and cytokines in order to evaluate
an effect on immune dysregulation.

Inclusion Criteria:

- Males and females age 18-64 years who are inadequately controlled on H1 and/or
H2-blocker therapy for chronic urticaria

- The Urticaria Activity Score must have a score of at least 2 (one point from each of
the two categories: number of hives and severity of pruritus).

Exclusion Criteria:

- Urticaria secondary to vasculitis

- Use of prednisone, hydroxychloroquine, cyclosporine, or a tricyclic antidepressant
(except Doxepin) within the 30 days prior to enrollment

- A history of anaphylaxis

- Non-controlled or debilitating chronic diseases (poorly controlled diabetes or
congestive heart failure)

- An immune system disorder

- Deranged stress hormone level (for example, Cushing's disease)

- Ongoing omalizumab therapy

- Nocturnal employment (which would effect study measures, such as cortisol levels).