Natural history, prognostic factors and patient perceived response to treatment in chronic spontaneous urticaria

Abstract

Background: Although the diagnosis and management of chronic spontaneous urticaria (CSU) is well documented in the literature, some aspects of the disease remain unclear. We aimed to further describe the natural history, prognostic factors, humanistic burden and uptake of traditional and alternative therapies in patients with CSU. Methods: This was a prospective, cross-sectional analysis at a single centre. We reviewed patient medical records and conducted a survey in patients with CSU. Results: 72 patients participated in the study with a median duration of CSU of 48 months. 30% of patients had symptoms that resolved in under 2 years with these patients trending towards an older age of onset of CSU (48 ± 17 years). 16% of patients had symptoms lasting 10 years or longer with these patients trending towards a younger age of onset (22 ± 16 years). Patients with a relapsing/remitting disease course (31%) and those with co-existing angioedema (57%) trended towards a longer median duration of CSU (96 and 50 months respectively) and were observed to have a higher proportion of patients reporting CSU duration of 10 years or longer (33% and 25%, p = 0.033 and p = 0.036 respectively). Patients with co-existing autoimmune/thyroid disease (19%) trended towards a shorter median duration of CSU (37 months). 54 patients (75%) reported sleep disturbance and 29 patients (43%) required emergency room visit(s) for symptomatic control. 84% of patients who trialed second generation antihistamines reported a response to treatment, while 73% of patients who trialed omalizumab reported a response to treatment. Patients using alternative medicine such as acupuncture, traditional Chinese medicine and naturopathic medicine had lower reported response rates (20-29%) to treatment. Conclusions: The natural history of CSU may be longer than previously reported with our study finding a median duration of symptoms of nearly 4 years with one-third of patients reporting a relapsing/remitting disease course. Younger age of onset, a relapsing/remitting disease course and angioedema may predict a longer duration of CSU, whereas older age of onset and co-existing autoimmune/thyroid disease may predict a shorter duration of CSU. Reported symptomatic benefit was higher from guidelines based pharmacologic therapy versus various alternative medicines.

Predicting Clinical Remission of Chronic Urticaria Using Random Survival Forests: Machine Learning Applied to Real-World Data

“…Some of the clinical variables identified by our model as important in predicting time to clinical remission have been previously reported in literature (e.g., older age at diagnosis, asthma, allergic rhinitis, and high BMI) [ 6 , 10 , 29 , 31 – 35 ]. However, there were other variables not identified by our model as important in predicting time to clinical remission but that, nonetheless, have been reported to be associated with time to clinical remission in other studies using different designs and target populations [ 34 , 35 ].…”

“…Published evidence suggests that patients with CU experience a wide range of cumulative remission rates ranging between 10% and 38% at 1 year and 30% and 71% at 5 years [ 6 ], and reach clinical remission at varying times with average disease duration between 3 and 5 years in adults [ 4 , 7 – 9 ]. Several demographic and clinical characteristics influencing the duration of active disease among patients with CU have been reported (e.g., age, gender, presence of angioedema, hypertension), although the data are limited and inconclusive for many reasons, such as variability in patient profiles, small sample sizes, and a lack of consensus on the definition of disease remission [ 8 – 10 ].…”

The burden of symptomatic patients with chronic spontaneous urticaria: a real-world study in Korea

“…Health-related quality of life scores according to Urticaria Activity Score over 7 days (UAS7)-diasese activity. Patients were divided into four groups according to their UAS7 score: well-controlled (≤ 6), mild (7)(8)(9)(10)(11)(12)(13)(14)(15), moderate (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27), and severe (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42). The mean scores of Chronic Urticaria Quality of Life questionnaire (CU-QoL), EuroQol 5-Dimension (EQ-5D), and Dermatology Life Quality Index (DLQI) in each disease activity are presented.…”

“…CU can be classified as chronic spontaneous urticaria (CSU), previously recognized as chronic idiopathic urticaria, with the spontaneous appearance of hives and angioedema due to unknown cause, and chronic inducible urticaria (CIndU) for which specific eliciting factors are involved [1]. The worldwide prevalence of CSU is reported to vary between 0.02% and 5.0%, with women having a disproportionately higher incidence and a median age of onset in the 50s [2][3][4][5][6][7]. The prevalence of CSU in the Korean population ranges between 0.16% and 2.3%, at a similar level [2].…”

New Biological Treatment Options in CSU

“…CSU duration was associated with the presence of angioedema and disease severity. In a recent study, younger CSU patients (22 ± 16 years) tended to have a significantly longer course, were in 16% of patients, CSU symptoms lasted over ten years [2,3]. In addition to its prolonged duration, CSU severely affects quality of life and is associated with comorbidities such as lack of sleep, impairments in work productivity, and depression/anxiety.…”