Health-Related Quality of Life in Chronic Urticaria: A Systematic Review and Meta-Analysis

Gabriel Berberi; Mahan Maazi; Connor Prosty; Eric P McMullen; Michael Fein; Hermenio Lima; Elvis Martinez-Jaramillo; Moshe Ben-Shoshan; Farhad Pourpanah; Elena Netchiporouk

doi:10.1016/j.jaip.2025.03.049

Health-Related Quality of Life in Chronic Urticaria: A Systematic Review and Meta-Analysis

J Allergy Clin Immunol Pract. 2025 Apr 8:S2213-2198(25)00314-9. doi: 10.1016/j.jaip.2025.03.049. Online ahead of print.

Authors

Affiliations

¹ Faculty of Medicine, McGill University, Montreal, QC, Canada.
² Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
³ Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁴ Division of Allergy and Clinical Immunology, McGill University, Montreal, QC, Canada.
⁵ Division of Dermatology, McMaster University and LEADER research, Hamilton, ON, Canada.
⁶ Division of Dermatology, McGill University, Montreal, QC, Canada.
⁷ Division of Dermatology, McGill University, Montreal, QC, Canada. Electronic address: elena.netchiporouk@mcgill.ca.

PMID: 40209927
DOI: 10.1016/j.jaip.2025.03.049

Abstract

Background: Chronic Urticaria, CU, including Chronic Spontaneous Urticaria, CSU and Chronic Inducible Urticaria, CIndU, significantly affect patients' health-related quality of life, HRQOL. To date, no systematic reviews or meta-analyses have summarized the HRQOL tools used in CU and the magnitude of HRQOL impact in CU.

Objective: To determine the HRQOL tools used in CU, the burden of CU regarding HRQOL in adults and children, and whether CU subtypes differentially impact HRQOL.

Methods: We searched MEDLINE, Embase, Web of Science, Cochrane, CINAHL, and PsycINFO from inception to August 20^th, 2023, for original articles including populations of adult or pediatric patients with CU or any of its subtypes where HRQOL was reported using any quality-of-life instrument. We conducted a series of meta-analyses to pool and compare data on HRQOL outcomes by CU subtype, primarily utilizing the Dermatologic Quality of Life Index, DLQI.

Results: We identified 123 publications reporting on 23,508 unique patients with CU and/or its subtypes. The meta-analysis revealed a moderate to large impact of CU and its subtypes on HRQOL. In adults, pooled mean DLQI score was 8.9, 95%CI=7.7-10.1 for CU, 11.0, 95%CI=9.3-12.7 for CSU, 8.3, 95%CI=6.8-9.8 for CIndU, and 10.0, 95%CI=7.7-12.4 for concomitant CSU/CIndU. In children with CSU, the mean CDLQI score was 6.9, 95%CI=1.9-12.0. The analysis revealed high heterogeneity, likely due to differences in patient population and study design.

Conclusion: CU and its subtypes significantly impair HRQOL. The clinical implication of the differences between CU subtypes needs to be further explored, along with additional research in pediatric populations.

Keywords: Chronic Inducible Urticaria; Chronic Spontaneous Urticaria; Chronic Urticaria; Health-Related Quality of Life.