The role of patient-reported outcomes in the management of chronic spontaneous urticaria

Chronic spontaneous urticaria (CSU) is a debilitating condition affecting 0.5–1% of the population worldwide. It typically presents with transient hives (wheals) that last for at least 6 weeks, often with concomitant angioedema (Maurer et al, 2011; Zuberbier, 2012). Available evidence indicates that CSU can substantially affect patients' quality of life (QoL), their ability to perform daily tasks and their mental health (O'Donnell et al, 1997; Kang et al, 2009; Vietri et al, 2015; Balp et al, 2017; Mendelson et al, 2017).

International urticaria guidelines on the management of CSU have been jointly developed by the European Academy of Allergy and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO) (Zuberbier et al, 2018). The guidelines state that the goal of treatment is symptom control or remission. The therapeutic approach to CSU often involves the identification and elimination of underlying causes, the avoidance of eliciting factors and the use of pharmacological treatment. Treatment should follow the treat-to-target strategy of treating as much as needed and as little as possible, which may mean stepping up or stepping down in the treatment algorithm according to the course of CSU. Re-evaluating the need for continued or alternative drug treatment is recommended because the severity of urticaria may fluctuate and spontaneous remission may occur.