Beyond the Wheals: mapping the road of Chronic Urticaria from Primary to Specialized Care: Real-world insights into the course and care of chronic urticaria

Urticaria is a skin disease characterized by transient itchy wheals (hives) and/or recurrent swellings of the skin (angioedema). When symptoms last longer than six weeks, it is defined as chronic urticaria. Symptoms can occur spontaneously (chronic spontaneous urticaria) or are triggered by specific stimuli (chronic inducible urticaria).
Research into the early phase of the disease among nearly 17,000 urticaria patients in primary care showed that the majority has a short disease duration of one week. Nonetheless, one in six patients develops chronic urticaria. Each year, approximately 1 in 200 to 300 patients consult their general practitioner for this condition. Older age, higher body mass index (BMI) and higher disease activity at first presentation were associated with a prolonged disease course. These insights may help general practitioners recognize patients at risk of chronic urticaria earlier and initiate timely and adequate treatment.
International research among 2,325 patients with severe chronic urticaria confirmed that omalizumab is both effective and safe: 80% achieved well-controlled disease and only a small proportion discontinued treatment due to ineffectiveness or side effects. On average, patients are treated for over three years, and in case of well-controlled disease on average seven years. A higher dosage of omalizumab is a valuable option in case of insufficient disease control, with benefit more likely in those with partial response to standard dosage. Although patients with chronic inducible urticaria and isolated angioedema often have limited access to omalizumab worldwide, large daily-practice studies showed good effectiveness in these populations.
Together, these findings contribute to more personalized care for patients with urticaria, from initial presentation to long-term management.