Physician estimation of the prevalence and clinical impact of chronic urticaria: Results of the global, multicenter UCARE CU-PAPER study

Pavel Kolkhir^1,2*Hanna Bonnekoh^1,2Berenike Maria Kern^1,2Felix Aulenbacher^1,2Ivan Cherrez-Ojeda^1,2,3,4Jason Hawkes^5,6Emek Kocatürk^1,2,7Philip Hei Li⁸Iman Nasr⁹Pascale Salameh^{1,10,11,12,13,2}

• ¹Charité University Medicine Berlin, Berlin, Germany
• ²Fraunhofer-Institut fur Digitale Medizin MEVIS, Bremen, Germany
• ³Universidad Espiritu Santo, Samborondon, Ecuador
• ⁴Respiralab Research Group, Guayaquil, Ecuador
• ⁵Oregon Health & Science University, Portland, United States
• ⁶Oregon Medical Research Center, Portland, United States
• ⁷Bahçeşehir University School of Medicine, Department of Dermatology, Istambul, Türkiye
• ⁸Division of Rheumatology & Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, SAR China
• ⁹Immunology and Allergy Unit Royal Hospital, Oman, Oman
• ¹⁰Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
• ¹¹Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
• ¹²Department of Primary Care and Population Health, University of Nicosia Medical School 2408, Nicosia, Cyprus
• ¹³Institut National de Sante Publique d'Epidemiologie Clinique et de Toxicologie, Beirut, Lebanon

Introduction: Chronic urticaria (CU) is a common, burdensome mast cell-mediated skin disease. However, little is known about physician estimation of the disease prevalence and clinical impact. This study assessed physicians' perceptions of CU and compared them with data from peer-reviewed literature. Methods: We conducted a cross-sectional, questionnaire-based study distributed worldwide via UCARE (Urticaria Centers of Reference and Excellence) network to 198 UCAREs and forwarded to GPs (general practitioners). Questionnaire data was analyzed using SPSS and subgroup analysis was performed using appropriate non-parametric statistical tests depending on the number of comparison groups and the distribution of the data. Results: In total, 234 participants from 46 countries completed the survey (54.3% female, median age: 48.5, interquartile range (IQR): 38.3-58.0 years). Median disease onset reported for chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU) was 30.0 and 25.0 years, respectively. Median estimated prevalence of CU in adult and pediatric patients was 2.5% and 1.0%, respectively. The most affected aspects of patient life, estimated by physicians, were sleep (CSU), physical activities (CIndU), and mental status (CSU, CIndU). Physicians working at UCARE (78.9% (183/232) versus non-UCARE (21.1% (49/232) sites differed in their estimation of adult CU prevalence (median: 2.0% vs. 4.5%, p<0.001), proportion of adult CSU patients among CU patients (median: 70.0% vs. 60.0%, p=0.027), and proportion of CSU patients with severe impact (median: 50.0% vs. 30.0%, p=0.042). When asked how confident participants were in their estimations regarding CU prevalence and burden, UCARE experts reported significantly higher median confidence compared to other physicians. Conclusion: Although physicians' estimations of CU prevalence and burden generally align with literature data, non-UCARE physicians may underestimate the burden and overestimate the prevalence. This might affect CU management in primary care as in potentially leading to a less effective treatment and underscores the need for increased urticaria awareness among non-UCARE physicians via publications, masterclasses, webinars, or other educational initiatives.