Chronic urticaria harms quality of life

Published online April 8, 2025

Chronic urticaria (CU) is a debilitating skin condition characterized by persistent hives, itching, and sometimes angioedema lasting more than six weeks. It occurs in two main forms: chronic spontaneous urticaria (CSU), where no clear trigger is identified, and chronic inducible urticaria (CIndU), which is triggered by physical stimuli such as cold, pressure, or sunlight. CU significantly interferes with patients' sleep, emotional well-being, daily functioning, and social interactions. Until now, the overall impact of CU on quality of life had not been fully quantified across its subtypes or age groups.

In this comprehensive systematic review and meta-analysis, Berberi et al. analyzed data from 123 studies involving over 23,500 adults and children with CU to evaluate its impact on health-related quality of life (HRQOL). Published in The Journal of Allergy and Clinical Immunology: In Practice, the study is the largest synthesis to date on this topic. The team reviewed which HRQOL tools were used and how CU and its subtypes—CSU, CIndU, and mixed forms—affected patient well-being. Using standardized instruments such as the Dermatology Life Quality Index (DLQI) and the CU-specific CU-Q2oL, the study pooled scores and compared results across populations. The authors also examined differences in HRQOL between CSU and CIndU, as well as in pediatric versus adult patients. Importantly, they identified significant gaps in validated tools for children and for people living with CIndU.

CU was found to have a moderate to large negative impact on HRQOL, especially in adults with CSU. The pooled mean DLQI scores ranged from 8.3 to 11.0 across CU subtypes, indicating moderate to severe impairment. Pediatric data were limited, but available results also suggested substantial burden. While CSU patients had slightly worse HRQOL scores than those with CIndU, the difference was not statistically significant. The review also highlighted a lack of CU-specific tools for pediatric patients and noted that generic tools like the DLQI may underestimate the condition’s true impact, especially in relation to unpredictability, flare anxiety, and sleep loss. These findings underscore the need for targeted patient-reported outcome measures and treatment strategies that prioritize full symptom resolution.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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