Assessment Tools

Assessment Tools for Disease Activity and Impact in CSU

International urticaria guidelines recommend the use of tools in CSU patients to measure and monitor disease activity and health-related quality of life (HRQoL) (Zuberbier et al., 2018). Physicians have a choice of tools (generic of CSU specific) to assess the severity impact of CSU and treatment response. In CSU changes in symptom severity are closely linked to changes in HRQoL (Stull et al., 2016).

Table 2. Disease activity and impact tools

Disease activity and impact tools.

The Urticaria Activity Score (UAS)

The UAS is a validated daily measure, encompassing hives and itch, to assess urticaria severity and monitor treatment outcomes (Zuberbier et al., 2018; Młynek et al., 2008).

Table 3. UAS

Urticaria Activity Score (UAS).

The daily UAS (range, 0-6) equals the sum of daily Itch Severity Score (ISS) and the hives score.

The UAS7 (range, 0-42) is a weekly composite of the daily UAS and is used to measure disease activity over 7 days.

UAS7 Score.

Figure 7. UAS7 Score.

UAS7 is a measure of CSU severity over 7 days (Zuberbier et al., 2018; Maurer et al., 2011).

UAS7 Score.

Figure 8. UAS7 Score.
1, Zuberbier et al., 2018; 2, Baiardini et al., 2005.

A variation of the UAS7, the UAS7TD was recently assessed to determine whether the UAS7 could be used to divide patients into subgroups to better assess impact on quality of life. It was found that categorical UAS7 subgroups could be used to predict differences among patients with different levels of disease severity – this may enable better clinical monitoring of treatment efficacy (Stull et al., 2017).

The Angioedema Activity Score (AAS)

The AAS is used to assess disease activity in patients with recurrent angioedema (Zuberbier et al., 2018).

The AAS allows the patient to score each of five key factors relating to their symptoms from 0 to 3 (giving a daily score of 0–15). Daily AAS can be summed to give 7-day scores (AAS7), 4-week scores (AAS28), and 12-week scores (AAS84) (Weller et al., 2013).

The Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL)

The CU-Q2oL patient questionnaire was designed and validated for the assessment of QoL specifically in chronic urticaria, including the physical, psychosocial and practical aspects of this condition (Baiardini et al., 2011). It consists of 23 questions covering six key domains relevant to:

  • Pruritus
  • Swelling
  • Impact on life activities
  • Sleep problems
  • Looks

The effects of disease on each domain are scored from 1 (not at all) to 5 (extremely) and totalled to give an overall score ranging from 0–92 with higher scores indicating a greater impairment in QoL. The CU-Q2oL is simple to administer, and requires approximately five minutes to complete (Baiardini et al., 2011).

The Angioedema Quality-of-Life Questionnaire (AE-QoL)

The AE-QoL is the first angioedema-specific patient-reported QoL questionnaire. It consists of 17 questions across 4 domains (Weller et al., 2012):

AE-QoL Questionnaire Domains.

Figure 9. AE-QoL Questionnaire Domains.

The Dermatology Life Quality Index (DLQI)

DLQI is a validated and widely used dermatology-specific patient questionnaire for evaluating HR-QoL in patients with a variety of skin conditions including CSU (Finlay & Khan, 1994; Młynek et al., 2008). It is used in clinical practice and trials but was not included in the last international urticaria guidelines (Zuberbier, et al. 2018).

The Urticaria Control Test (UCT)

The UCT is a single questionnaire comprised of four questions designed to evaluate the physical symptoms of chronic urticaria (itch, hives and/or angioedema), the impact on HR-QoL and the effectiveness of treatment over four weeks (Weller et al., 2012). It consists of just four simple questions allowing rapid and easy completion and is valid for both CSU and CIndU.