Additionally, the higher rates of thyroid and autoimmune diseases, obesity, CRP and systemic symptoms in females than in males in this age group support a multifactorial effect; hormonal, metabolic and immune changes lead to increased inflammatory cytokines and adipokines, thereby contributing to CSU by increasing inflammation and immune dysregulation.23 The gene discussed is CRP; the disease is obesity due to melanocortin 4 receptor deficiency.