Impact of Chronic Urticaria on Patients' Quality of Life and Society
An international team of dermatologists has mapped out the impact of chronic urticaria on various aspects of patients' lives and the economic burden this long-term disease, without available causal treatment, represents for society, according to available literature.
Long-term nature of chronic urticaria
Chronic urticaria is defined as the occurrence of hives or angioedema lasting longer than 6 weeks. Lesions can appear either spontaneously (CSU – chronic spontaneous urticaria) or as a reaction to certain triggers – friction, cold, heat, sunlight, pressure, or physical exertion (CIndU – chronic inducible urticaria). Angioedema is present in 40–60% of patients with chronic urticaria. This condition appears at least once in a lifetime in 4.4% of the population, with the overall prevalence at a given time point estimated at 0.7%. The average duration of the disease is 11.5 ± 10.8 years.
Difficult-to-treat disease
More than a quarter of cases show resistance to H1 antihistamines even at high doses, and when treated with 3rd and 4th line therapies (omalizumab and cyclosporin), disease control is achieved in only 2/3 of these patients.
Adverse effects on sleep, daily activities, family and social life
Chronic urticaria can significantly impact health-related quality of life (HRQoL), especially when angioedema is present. For 30% of patients, the score of the patient-completed questionnaire DLQI (Dermatology Life Quality Index) > 10. The main factors responsible for the physical, social, and emotional impact of CSU are the sudden and unpredictable appearance of hives and angioedema, as well as pruritus, which significantly affects sleep, sexual life, everyday activities, work, sports activities, family and social life, and performance in jobs or school. More than 30% of patients present with psychological comorbidities like anxiety and depression. For patients with CIndU, HRQoL is further reduced by the need to avoid triggers. Quality of life is also lower in the case of angioedema, which can be painful and, depending on its location, limit many activities or breathing.
Economic costs
Direct costs of treating patients with chronic urticaria – including pharmacotherapy, regular check-ups with the doctor, emergency treatments, laboratory tests, and hospitalizations – are estimated in Europe and the USA at $900–2400 (adjusted for purchasing power parity) per patient per year. The disease is also associated with significant indirect costs.
Conclusion
Given that the cause of chronic urticaria usually cannot be identified and eliminated, there is no curative treatment; long-term symptomatic therapy is necessary to mitigate symptoms and improve quality of life.
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Source: Gonçalo M., Gimenéz-Arnau A., Al-Ahmad M. et al. The global burden of chronic urticaria for the patient and society. Br J Dermatol 2021 Feb; 184 (2): 226–236, doi: 10.1111/bjd.19561.
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