Burden of Disease

Chronic spontaneous urticaria can have a major impact on those affected, on a physical, mental, emotional, financial and social level. In this section we explore the effects of the condition on patients' quality of life.

The impact on patients’ lives goes beyond effects on skin; currently treated patients experience higher levels of health-related impairment in their functioning in work and non-work activities and quality of life, and are more frequent users of healthcare than similar individuals without the condition (Balp et al., 2015).

 

Quality of Life

CSU adversely affects many aspects of patients’ lives (Maurer et al., 2011).

Chronic spontaneous urticaria (CSU) impacts on quality of life.

Figure 3. The impacts of CSU on quality of life.

How CSU impacts on patients’ day-to-day lives

  • 73% of CSU patients report that their sexual relationships are directly affected by their condition (O’Donnell et al., 1997)
  • Nearly 50% of patients feel like crying at least once a week due to their CSU symptoms (Allergy UK, 2014)
  • 73% are restricted in their physical activities (O’Donnell et al., 1997)
  • Up to 50% of patients show inadequate symptomatic relief from H1- antihistamines at licensed doses (Maurer et al., 2011)
    • Up-dosing of H1-antihistamines resulted in significant improvement in symptom control for approximately 30–50% of those patients who needed it (Weller et al., 2011; van den Elzen et al., 2017)
  • 56% of patients report not having control over their CSU symptoms (Allergy UK, 2014)
  • 73% cancel invitations to social occasions (O’Donnell et al., 1997)
  • 84% feel restricted going out for dinner or a drink (O’Donnell et al., 1997)

Many aspects of quality of life (QoL) are found to be reduced in patients with CSU (Kang et al., 2009) and the presence of angioedema further impairs QoL scores (Silvares et al., 2011). The QoL of patients with CSU is at least as impaired as in patients with other skin diseases, with higher impact on daily living and physical discomfort (Staubach et al., 2006).

Measurement of patient QoL in CSU
​Patient QoL in CSU may be measured using specific skin disease questionnaires such as the Dermatology Quality of Life Index (DQLI) (Finlay et al., 1994; Mlyneck et al., 2008).

 

Factors contributing to a reduced QoL

In addition to the classical symptoms associated with CSU, factors of major importance to patients that contribute to a reduced QoL include (Gattey et al., 2015):

  • Unpredictability of attacks
  • Persistent lack of sleep
  • Fatigue
  • Disfigurement

Patients with CSU also often have comorbidities such as depression and anxiety (Engin et al., 2008). Sixty-three per cent of CSU patients report anxiety at some point during their flares (Gattey et al., 2015) and 17% are diagnosed with depressive or somatoform disorders (Stauchbach et al., 2011).

The impact on patients’ lives goes beyond effects on skin; currently treated patients experience higher levels of health-related impairment in their functioning in work and non-work activities and quality of life, and are more frequent users of healthcare than similar individuals without the condition (Balp et al., 2015).

 

Disease that is refractory to antihistamines is also potentially a much larger problem than previously believed. The German AWARE study published some preliminary results suggesting that antihistamine-refractory patients demonstrated high levels of uncontrolled disease, angioedema and co-morbid chronic inducible urticaria. They were noted to have impaired quality of life, be generally undertreated, and are increasingly dependent on healthcare services (Maurer et al., 2017).

The Scandinavian arm of the AWARE study reported similar findings, noting high rates of healthcare utilisation and quality of life impairment (Thomsen et al., 2017).

The Socioeconomic Burden

The socioeconomic cost of CSU is high in terms of direct medical costs and indirect costs, such as lost wages because of absences from work (Maurer et al., 2011; DeLong et al., 2008). It is estimated that approximately 60–70% of patients report absence from work or school as a direct result of their CSU (DeLong et al., 2008; Gattey et al., 2015) and 26% report that it causes three or more days’ absence a year (DeLong et al., 2008). Patients with severe CSU incur higher direct and indirect costs than patients with mild or moderate disease. Most patients, particularly those with angioedema, will need continuous medication to alleviate symptoms and regular visits to healthcare facilities (DeLong et al., 2008; Maurer et al., 2011).

The impact on patients’ lives goes beyond effects on skin; currently treated patients experience higher levels of health-related impairment in their functioning in work and non-work activities and quality of life, and are more frequent users of healthcare than similar individuals without the condition (Balp et al., 2015).