CoChat
Sign Up
Cited by 383Urticaria and Related ConditionsMast cells and histamineDermatology and Skin Diseases

The burden of chronic spontaneous urticaria is substantial: Real‐world evidence from ASSURE ‐ CSU

Open access
Maurer, M., Abuzakouk, M., Bérard, F., Canonica, W., Oude Elberink, H., Giménez‐Arnau, A., Grattan, C., Hollis, K. +14 more·2017·Allergy
DOI 10.1111/all.13209PMC PMC5724512
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Chronic spontaneous urticaria (CSU) can be debilitating, difficult to treat, and frustrating for patients and physicians. Real-world evidence for the burden of CSU is limited. The objective of this study was to document disease duration, treatment history, and disease activity, as well as impact on health-related quality of life (HRQoL) and work among patients with inadequately controlled CSU, and to describe its humanistic, societal, and economic burden. METHODS: This international observational study assessed a cohort of 673 adult patients with CSU whose symptoms persisted for ≥12 months despite treatment. Demographics, disease characteristics, and healthcare resource use in the previous 12 months were collected from medical records. Patient-reported data on urticaria and angioedema symptoms, HRQoL, and work productivity and activity impairment were collected from a survey and a diary. RESULTS: Almost 50% of patients had moderate-to-severe disease activity as reported by Urticaria Activity Score. Mean (SD) Dermatology Life Quality Index and Chronic Urticaria Quality of Life Questionnaire scores were 9.1 (6.62) and 33.6 (20.99), respectively. Chronic spontaneous urticaria markedly interfered with sleep and daily activities. Angioedema in the previous 12 months was reported by 66% of enrolled patients and significantly affected HRQoL. More than 20% of patients reported ≥1 hour per week of missed work; productivity impairment was 27%. These effects increased with increasing disease activity. Significant healthcare resources and costs were incurred to treat CSU. CONCLUSIONS: Chronic spontaneous urticaria has considerable humanistic and economic impacts. Patients with greater disease activity and with angioedema experience greater HRQoL impairments.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1111/all.13209

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Achieving timely diagnosis and optimal symptom control remains challenging due to the unpredictable nature of chronic urticaria.

    “Despite the existence of specialized UCARE centers and various participation opportunities in the diagnostic and therapeutic process, achieving a timely diagnosis and optimal symptom control remains challenging due to the unpredictable nature of CU, which significantly burdens the affected individuals [7].”

    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 [7]

    The Discussion reports substantial delays from symptom onset to diagnosis and persistent moderate-to-severe symptoms; the Conclusions also describe CSU as challenging to treat adequately. The Introduction says CSU has no identifiable specific triggers, but the paper does not establish that its unpredictable nature causes the diagnostic delays or difficulty controlling symptoms. The findings concern chronic spontaneous urticaria specifically, rather than all chronic urticaria. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Urticaria can lead to sleep problems, difficulties in everyday activities, and a strong increase in anxiety and stress.

    “Urticaria can lead to sleep problems, difficulties in everyday activities, and a strong increase in anxiety and stress [6–8].”

    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 [7]

    The Results section ('CSU has a major impact on HRQoL, sleep, and daily life'; page not provided) reports interference with sleep and daily activities, and says 47.4% of patients reported moderate or extreme anxiety/depression problems. It does not establish a strong increase in anxiety or measure stress, so that part of the claim is not supported. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Other 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 [7]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

No references could be resolved yet.

Research works printed but not linked: 42

  1. [1]Maurer M, Bindslev‐Jensen C, Gimenez‐Arnau A, et al. Chronic idiopathic urticaria (CIU) is no longer idiopathic: time for an update!. Brit J Dermatol. 2013; 168: 455‐ 456. 22835147
  2. [2]Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA(2) LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014; 69: 868‐ 887. 24785199
  3. [3]Toubi E, Kessel A, Avshovich N, et al. Clinical and laboratory parameters in predicting chronic urticaria duration: a prospective study of 139 patients. Allergy. 2004; 59: 869‐ 873. 15230821
  4. [4]van der Valk P, Moret G, Kiemeney L. The natural history of chronic urticaria and angioedema in patients visiting a tertiary referral centre. Br J Dermatol. 2002; 146: 110‐ 113. 11841375
  5. [5]Gaig P, Olona M, Muñoz Lejarazu D, et al. Epidemiology of urticaria in Spain. J Investig Allergol Clin Immunol. 2004; 14: 214‐ 220. 15552715
  6. [6]Beltrani VS. An overview of chronic urticaria. Clin Rev Allergy Immunol. 2002; 23: 147‐ 169. 12221861
  7. [7]Sánchez‐Borges M, Caballero‐Fonseca F, Capriles‐Hulett A, González‐Aveledo L, Maurer M. Factors linked to disease severity and time to remission in patients with chronic spontaneous urticaria. J Eur Acad Dermatol Venereol. 2017; 31: 964‐ 971. 28299827
  8. [8]Kulthanan K, Jiamton S, Thumpimukvatana N, Pinkaew S. Chronic idiopathic urticaria: prevalence and clinical course. J Dermatol. 2007; 34: 294‐ 301. 17408437
  9. [9]Maurer M, Weller K, Bindslev‐Jensen C, et al. Unmet clinical needs in chronic spontaneous urticaria: a GA²LEN task force report. Allergy. 2011; 66: 317‐ 330. 21083565
  10. [10]Guillén‐Aguinaga S, Jáuregui Presa I, Aguinaga‐Ontoso E, Guillén‐Grima F, Ferrer M. Up‐dosing non‐sedating antihistamines in patients with chronic spontaneous urticaria: a systematic review and meta‐analysis. Br J Dermatol. 2016; 175: 1153‐ 1165. 27237730
  11. [11]Reeves GE, Boyle MJ, Bonfield J, Dobson P, Loewenthal M. Impact of hydroxychloroquine therapy on chronic urticaria: chronic autoimmune urticaria study and evaluation. Intern Med J. 2004; 34: 182‐ 186. 15086698
  12. [12]Maurer M, Magerl M, Metz M, Zuberbier T. Revisions to the international guidelines on the diagnosis and therapy of chronic urticaria. J Dtsch Dermatol Ges. 2013; 11: 971‐ 978. 24034140
  13. [13]O'Donnell BF, Lawlor F, Simpson J, Morgan M, Greaves MW. The impact of chronic urticaria on the quality of life. Br J Dermatol. 1997; 136: 197‐ 201. 9068731
  14. [14]Kang MJ, Kim HS, Kim HO, Park YM. The impact of chronic idiopathic urticaria on quality of life in Korean patients. Ann Dermatol. 2009; 21: 226‐ 229. 20523794 PMC2861226
  15. [15]Balp MM, Vietri J, Tian H, Isherwood G. The impact of chronic urticaria from the patient's perspective: a survey in five European countries. Patient. 2015; 8: 551‐ 558. 26476961 PMC4662955
  16. [16]Mendelson MH, Bernstein JA, Gabriel S, et al. Patient‐reported impact of chronic urticaria compared with psoriasis in the United States. J Dermatolog Treat. 2016; 28: 229‐ 236. 27577257
  17. [17]Vietri J, Turner SJ, Tian H, Isherwood G, Balp MM, Gabriel S. Effect of chronic urticaria on US patients: analysis of the National Health and Wellness Survey. Ann Allergy Asthma Immunol. 2015; 115: 306‐ 311. 26265010
  18. [18]Weller K, Maurer M, Grattan C, et al. ASSURE‐CSU: a real‐world study of burden of disease in patients with symptomatic chronic spontaneous urticaria. Clin Transl Allergy. 2015; 5: 29. 26284152 PMC4538755
  19. [19]Zuberbier T, Asero R, Bindslev‐Jensen C, et al. EAACI/GA(2)LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy. 2009; 64: 1417‐ 1426. 19772512
  20. [21]EuroQol Group. EuroQol—a new facility for the measurement of health related quality of life. Health Policy. 1990; 16: 199. 10109801
  21. [22]Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)—a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994; 19: 210‐ 216. 8033378
  22. [23]Baiardini I, Pasquali M, Braido F, et al. A new tool to evaluate the impact of chronic urticaria on quality of life: chronic urticaria quality of life questionnaire (CU‐Q2oL). Allergy. 2005; 60: 1073‐ 1078. 15969690
  23. [24]Młynek A, Magerl M, Hanna M, et al. The German version of the Chronic Urticaria Quality‐of‐Life Questionnaire: factor analysis, validation, and initial clinical findings. Allergy. 2009; 64: 927‐ 936. 19453340
  24. [25]Weller K, Groffik A, Magerl M, et al. Development and construct validation of the angioedema quality of life questionnaire. Allergy. 2012; 67: 1289‐ 1298. 22913638
  25. [26]Flood EM, Zazzali JL, Devlen J. Demonstrating measurement equivalence of the electronic and paper formats of the Urticaria Patient Daily Diary in patients with chronic idiopathic urticaria. Patient. 2013; 6: 225‐ 231. 23918000
  26. [27]Mathias SD, Dreskin SC, Kaplan A, Saini SS, Spector S, Rosén KE. Development of a daily diary for patients with chronic idiopathic urticaria. Ann Allergy Asthma Immunol. 2010; 105: 142‐ 148. 20674825
  27. [29]Stull D, McBride D, Tian H, et al. Analysis of disease activity categories in chronic spontaneous/idiopathic urticaria. Br J Dermatol. 2017; 177: 1093‐ 1101. 28295198
  28. [31]Hay JW, Smeeding J, Carroll NV, et al. Good research practices for measuring drug costs in cost effectiveness analyses: issues and recommendations: the ISPOR Drug Cost Task Force Report—Part I. Value Health. 2010; 13: 3‐ 7. 19874571
  29. [32]Liljas B. How to calculate indirect costs in economic evaluations. Pharmacoeconomics. 1998; 13(1 Pt 1): 1‐ 7. 10175982
  30. [34]Zuberbier T, Asero R, Bindslev‐Jensen C, et al. EAACI/GA(2)LEN/EDF/WAO guideline: management of urticaria. Allergy. 2009; 64: 1427‐ 1443. 19772513
  31. [35]Hongbo Y, Thomas CL, Harrison MA, Salek MS, Finlay AY. Translating the science of quality of life into practice: what do dermatology life quality index scores mean? J Invest Dermatol. 2005; 125: 659‐ 664. 16185263
  32. [36]Finlay AY. Current severe psoriasis and the rule of tens. Br J Dermatol. 2005; 152: 861‐ 867. 15888138
  33. [37]Broder MS, Raimundo K, Antonova E, Chang E. Resource use and costs in an insured population of patients with chronic idiopathic/spontaneous urticaria. Am J Clin Dermatol. 2015; 16: 313‐ 321. 26055728 PMC4529877
  34. [38]Delong LK, Culler SD, Saini SS, Beck LA, Chen SC. Annual direct and indirect health care costs of chronic idiopathic urticaria: a cost analysis of 50 nonimmunosuppressed patients. Arch Dermatol. 2008; 144: 35‐ 39. 18209166
  35. [39]Kapp A, Demarteau N. Cost effectiveness of levocetirizine in chronic idiopathic urticaria: a pooled analysis of two randomised controlled trials. Clin Drug Investig. 2006; 26: 1‐ 11. 17163229
  36. [40]Whiteley J, Emir B, Seitzman R, Makinson G. The burden of atopic dermatitis in US adults: results from the 2013 National Health and Wellness Survey. Curr Med Res Opin. 2016; https://doi.org/10.1080/03007995.2016.1195733. 27240604 · DOI
  37. [41]Yano C, Saeki H, Ishiji T, et al. Impact of disease severity on work productivity and activity impairment in Japanese patients with atopic dermatitis. J Dermatol. 2013; 40: 736‐ 739. 23834561
  38. [42]Schaefer CP, Cappelleri JC, Cheng R, et al. Health care resource use, productivity, and costs among patients with moderate to severe plaque psoriasis in the United States. J Am Acad Dermatol. 2015; 73: 585‐ 593. 26253364
  39. [43]Korman NJ, Zhao Y, Pike J, Roberts J. Relationship between psoriasis severity, clinical symptoms, quality of life and work productivity among patients in the USA. Clin Exp Dermatol. 2016; 41: 514‐ 521. 27061102
  40. [44]Kruntorádová K, Klimeš J, Šedová L, Štolfa J, Doležal T, Petříková A. Work productivity and costs related to patients with ankylosing spondylitis, rheumatoid arthritis, and psoriasis. Value Health Reg Issues. 2014; 4: 100‐ 106. 29702796
  41. [45]Ferrer M. Epidemiology, healthcare, resources, use and clinical features of different types of urticaria. Alergológica 2005. J Investig Allergol Clin Immunol. 2009; 19(Suppl 2): 21‐ 26. 19530414
  42. [46]Maurer M, Staubach P, Raap U, Richter‐Huhn G, Bauer A, et al. H1‐antihistamine‐refractory chronic spontaneous urticaria: it's worse than we thought—first results of the multicenter real‐life AWARE study. Clin Exp Allergy. 2017; 47: 684‐ 692. 28160338

Cited by

Sorted by citations

Authors
Maurer, M., Abuzakouk, M., Bérard, F., Canonica, W., Oude Elberink, H., Giménez‐Arnau, A., Grattan, C., Hollis, K., Knulst, A., Lacour, J. ‐., Lynde, C., Marsland, A., McBride, D., Nakonechna, A., Ortiz de Frutos, J., Proctor, C., Sussman, G., Sweeney, C., Tian, H., Weller, K., Wolin, D., & Balp, M. ‐.
Affiliations
  • Charité – Universitätsmedizin Berlin (DE)
  • Cleveland Clinic Abu Dhabi (AE)
  • Lyon 1 Université (FR)
  • IRCCS‐Humanitas Research Hospital Humanitas University Rozzano‐Milano Italy
  • University of Groningen Groningen The Netherlands
  • Universitat Autònoma de Barcelona (ES)
  • Guy's Hospital (GB)
  • RTI Health Solutions (US)
  • University Medical Center Utrecht (NL)
  • Université Nice Sophia Antipolis (FR)
  • Lynde Centre for Dermatology (CA)
  • University of Manchester (GB)
  • Royal Liverpool and Broadgreen University Hospital NHS Trust (GB)
  • Hospital 12 Octubre Madrid Spain
  • University of Toronto (CA)
  • Novartis (United States) (US)
  • Novartis (Switzerland) (CH)
Corresponding author
Maurer, M.
ORCID
Venue
Allergy
Publisher
Wiley
Published
2017-07-10
Volume
72
Issue
12
Pages
2005-2016
ISSN
  • 0105-4538 (ISSN-L)
  • 1398-9995
DOI
10.1111/all.13209
PMC
PMC5724512
OpenAlex
W2619731065
Cited by
383
References
0
Citations by year
2026: 63 · 2025: 63 · 2024: 47 · 2023: 38 · 2022: 46 · 2021: 50 · 2020: 27 · 2019: 27 · 2018: 19 · 2017: 3
FWCI
18.17
Type
journal article
Language
en
Open access
Licence
Locations
  • Allergy (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by-nc)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • Research Explorer (The University of Manchester) (submittedVersion, cc-by-nc)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by-nc)
  • Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion, cc-by-nc)
Funders
Novartis Pharma AG
Topics
  • Health Sciences › Medicine › Rheumatology › Urticaria and Related Conditions
  • Life Sciences › Immunology and Microbiology › Immunology › Mast cells and histamine
  • Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
Keywords
chronic spontaneous urticaria, disease burden, health-related quality of life, labor productivity, angioedema, disease activity, health care utilization, health care costs, missed work, sleep disorders, treatment history
MeSH terms
Activities of Daily Living, Adult, Aged, Aged, 80 and over, Chronic Disease, Cross-Sectional Studies, Female, Health Surveys, Humans, Male, Middle Aged, Quality of Life, Surveys and Questionnaires, Sleep, Urticaria, Health Care Costs, Cost of Illness, Guideline Adherence, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review