When the Immune System Turns Inwards: Investigating Autoimmune Patterns in Chronic Spontaneous Urticaria in Regional Practice

Introduction Chronic spontaneous urticaria (CSU) is increasingly recognised as an immune-mediated condition, with a significant proportion of cases linked to underlying autoimmunity. Yet in regional settings, patients often face delays in diagnosis and inconsistent access to targeted investigations. This study explores the presentation patterns and contributing factors of CSU in a nurse practitioner-led allergy clinic in regional Victoria, with a focus on autoimmune associations. Method A retrospective review was conducted of CSU presentations seen between June 2024 and June 2025. Data collected included patient demographics, symptom characteristics, and identified underlying contributors. Special attention was paid to indicators of autoimmune involvement, including thyroid dysfunction, autoantibodies, and family history. Results Thirty-eight patients presented with CSU during the 12-month period, with an average age of 30.2 years. Autoimmune markers or diagnoses were identified in 7 patients (18%), highlighting the significant role of immune dysregulation in this cohort. Low iron levels, often associated with autoimmune gastritis or menstrual dysfunction, were found in 12 patients. Hormonal factors (n = 5) and other contributors (n = 6), including infection and medication intolerance, were also observed. Eight cases remained idiopathic despite thorough investigation. Conclusion These findings reinforce the autoimmune underpinnings of CSU and the need for accessible immunological workup in regional care models. A nurse practitioner-led clinic provides a valuable platform for early detection and tailored management of autoimmune-associated urticaria, helping to reduce diagnostic delay and improve outcomes for patients often navigating complex and overlapping health issues.