Patients with Chronic Urticaria Remain Largely Undertreated: Results from the DERMLINE Online Survey
Open accessAbstract
INTRODUCTION: Chronic urticaria (CU) is an unpredictable disease, with high disease burden and a significant negative impact on quality of life, especially in patients of working age. Many patients are undertreated, and there is poor awareness of strategies to manage patients with CU in the real-world setting. The current study aimed to gain a better understanding of CU from the patients' perspective, including the body areas most affected by wheals and angioedema, the disease burden and current use of the healthcare system. METHODS: A nationwide online survey was performed in Germany involving individuals who reported a diagnosis of CU and experienced symptoms within 3 months prior to inclusion. RESULTS: This self-report survey included 1037 participants (89.2% female), with a mean ± standard deviation (SD) age of 33.4 ± 11.0 years and a mean ± SD disease duration of 10.0 ± 9.4 years. On average, participants suffered from urticaria symptoms for 3.0 ± 4.3 years before diagnosis. In 73% of participants, symptoms worsened due to external factors, with the majority specifying stress in their personal life or work-related stress as eliciting factors. Within the previous 3 months, 87.4 and 44.1% of participants experienced wheals and angioedema, respectively, at multiple body areas, and most (79.6%) participants had uncontrolled symptoms as measured with the Urticaria Control Test. Despite the high burden of disease, 60.3% of participants stated that they were not currently receiving treatment. The most commonly used therapies to treat CU were oral (72.8%) and non-prescription (43.3%) and prescription (47.3%) topical drugs, with 18.0% of the participants receiving injectable/infused drugs. CONCLUSION: The majority of the participants responding to the survey reported that CU is not sufficiently controlled, thereby severely influencing a highly productive time in their life. The body areas most affected by wheals and angioedema are specified, based on data provided by a large group of affected participants. A greater awareness of disease burden and available treatment options is needed.
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Treatment of chronic urticaria usually requires an interdisciplinary team, with dermatologists and general practitioners crucial and sometimes other specialists such as allergy.
“Treatment of CU usually requires an interdisciplinary team. Dermatologists and general practitioners are crucial, but sometimes, depending on the situation, specialists from other fields such as allergy are also needed [3].”
From Acceptance and perceived usefulness of digital health services in the management of chronic urticaria: a survey of patients and physicians (2025) · cites this paper as [3]
The Results section (Healthcare Utilization of Participants; page unavailable) reports that patients under treatment commonly saw dermatologists and/or general practitioners. It does not say that CU treatment usually requires an interdisciplinary team, that both providers are necessary, or that allergy specialists are sometimes needed. (LLM, conf=0.84)
Experimental — accuracy not yet measuredOther studies have reported a pattern of undertreatment and that guidelines are not properly followed.
“Other studies have reported that there is a pattern of undertreatment and that guidelines are not properly followed [3, 7, 14, 15].”
From Acceptance and perceived usefulness of digital health services in the management of chronic urticaria: a survey of patients and physicians (2025) · cites this paper as [3]
Angioedema occurs in up to 40% of cases of chronic urticaria.
“Angioedema also occurs in up to 40% of cases [1–4].”
From Acceptance and perceived usefulness of digital health services in the management of chronic urticaria: a survey of patients and physicians (2025) · cites this paper as [3]
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Cites
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“Indeed, numerous global reports have highlighted that patients with CSU are undertreated and are not receiving the recommended therapy [4, 11, 12], thus emphasizing the need for greater awareness and adherence to international guidelines.”
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Research works printed but not linked: 24
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Cited by
Sorted by citations
Hindelang, M., Sitaru, S., Fischer, C., Biedermann, T., & Zink, A. (2025) · JDDG: Journal der Deutschen Dermatologischen Gesellschaft · doi:10.1111/ddg.15557 · Cited by 7 · see citing works
Self-citationHindelang, M., Zink, A., Knitza, J., Darkow, R., Welcker, M., Biedermann, T., May, S., & Muehlensiepen, F. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-13043-7 · Cited by 4 · see citing works
“Our sample had a higher proportion of female participants, a trend seen in other studies on urticaria prevalence [3, 33, 34].”
Self-citation
- Authors
- Wagner, N., Zink, A., Hell, K., Reinhardt, M., Romer, K., Hillmann, E., Baeumer, D., & Schielein, M. C.
- Affiliations
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- Technical University of Munich (DE)
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (DE)
- Novartis (Germany) (DE)
- Corresponding author
- Wagner, Nicola
- Venue
- Dermatology and Therapy
- Published
- 2021-05-04
- Volume
- 11
- Issue
- 3
- Pages
- 1027-1039
- ISSN
- 2190-9172 (ISSN-L)
- 2193-8210
- PMC
- PMC8163939
- OpenAlex
- W3157917180
- Cited by
- 41
- References
- 2
- Citations by year
- 2026: 6 · 2025: 15 · 2024: 10 · 2023: 6 · 2022: 2 · 2021: 2
- FWCI
- 3.77
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Dermatology and Therapy (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- mediaTUM (Technical University of Munich) (submittedVersion, other-oa)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Funders
- Novartis Pharma GmbH
- Topics
- Health Sciences › Medicine › Rheumatology › Urticaria and Related Conditions
- Life Sciences › Immunology and Microbiology › Immunology › Mast cells and histamine
- Health Sciences › Medicine › Rheumatology › Eosinophilic Disorders and Syndromes
- Keywords
- chronic urticaria, undertreatment, disease burden, quality of life, angioedema, wheals, Urticaria Control Test, stress as trigger, topical treatment, real-world management
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