Urticaria - Treatment
The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria is an evidence- and consensus-based guideline developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group1.
The overall goal of treatment of urticaria is to treat the disease, efficiently and safely, until it is gone, aiming for continuous UAS7=0 (7 day- Urticaria Activity Score), complete control and a normalized quality of life. Guidelines recommend using several disease activity, disease control and Health-related quality of life measures to monitor disease and response to treatment.
The guideline recommends as therapeutic approach to chronic urticaria: (1) the search for and, if possible, elimination of underlying causes, which means healing the disease; (2) the avoidance of eliciting factors, reducing disease activity; (3) tolerance induction in patients with chronic inducible urticaria, reducing disease activity; (4) the use of pharmacological treatment to prevent mast cell mediator release and/or the effects of mast cell mediators, reducing disease activity.
Treatment should follow the principles of treating as much as needed and as little as possible taking into consideration that the activity of the disease may vary. This implies stepping up or stepping down in the treatment algorithm according to the course of disease following the principle assess, adjust, act, and reassess.
1. Zuberbier T, et al. Allergy. 2022; 77:734-766;
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The use of PROs to assess disease activity, impact and control of chronic spontaneous urticaria is recommended by guidelines at every visit.
Patient reported outcomes (PROs) provide health care professionals an opportunity to assess the patient’s condition from their own perspective1. Patient reported outcomes provide a holistic view of symptoms, quality of life and treatment effects and can influence how diseases are managed2. The EAACI/GA²LEN/EuroGuiDerm/APAAACI guidelines recommend use of PROs in clinical studies and clinical practice, in order to better define the effects and impact of CSU on patients3.
1. US Department of Health and Human Services (December 2009). Guidance for industry. Patient-reported outcome measures: use in medical product development to support labeling claims Available at: https://www.fda.gov/media/77832/download.;
2. Black et al. BMJ. 2013;346:f167;
3. Zuberbier T, et al. Allergy. 2022; 77:734-766;
4. Hopkinson K. Br J Nurs. 2019; 28:144–50;
5. Anker SD et al. European Heart Journal. 2014;35:2001–9;
6. Hollis K, et al. Am J Clin Dermatol. 2018;19:267–74;
7. Weller, et al. Allergy. 2013;68:1185–92;
8. Weller K, et al. J Allergy Clin Immunol. 2014;133:1365–72;
9. Van Geel MJ, et al. Br J Dermatol. 2016,174:152−7;
10. Vernon MK, et al. J Pain Symptom Manage. 2008;36:54–68;
Urticaria Activity Score (UAS) is a PRO that combines scores for itch severity and hives and reflects disease activity.
The Urticaria Activity Score (UAS) is a commonly used patient-reported outcome (PRO) that assesses two main symptoms of chronic spontaneous urticaria (CSU), itch severity and hive count1. EAACI/GA²LEN/EuroGuiDerm/APAAACI guidelines recommend the use of UAS as a validated tool in clinical practice1,2. UAS aids in assessing the disease activity in CSU. According to the treatment guidelines, the goal is to treat till the disease is gone3.
UAS is under copyright protection of the Global Allergy and Asthma European Network (GA2LEN- https://ga2len.net/) and is free for routine clinical use and non-commercial research.
1. Hollis K, et al. Am J Clin Dermatol. 2018;19:267–74;
2. Zuberbier T, et al. Allergy. 2014;69:868–87;
3. Zuberbier T, et al. Allergy. 2022; 77:734-766;
4. Mathias S, et al. Ann Allergy Asthma Immunol. 2012;108:20–4
Angioedema Activity Score (AAS) specifically assesses angioedema disease severity.
The Angioedema Activity Score (AAS) is used to assess activity in patients with recurrent angioedema1. The angioedema activity scale (AAS) includes questions relating to angioedema severity only and its impact on patient quality of life1.
It is recommended by EAACI/GA²LEN/EuroGuiDerm/APAAACI guidelines for the assessment of angioedema activity in chronic spontaneous urticaria patients with a goal to treat till the disease is gone2.
1. Weller K, et al. Allergy. 2013;68:1185–92;
2. Zuberbier T, et al. Allergy. 2022; 77:734-766;
3. AAS questionnaire. Available at https://moxie-gmbh.de/our-products/non-commercial-use/chronic-spontaneou.... (Accessed on Aug 04, 2021);
4. Weller K, et al. J Eur Acad Dermatol Venereol. 2015;29:38–44;
5.Staubach P, et al. Allergy. 2018;73:576–84MLR
Urticaria Control Test (UCT) assesses disease control in patients with CSU
The Urticaria Control Test (UCT) is a simple, validated, questionnaire-based patient-reported outcome to assess the level of disease control, performed once every 4 weeks1-3. UCT evaluates in one questionnaire the physical symptoms of urticaria (itch, hives and/or angioedema), the impact on HRQoL and the effectiveness of treatment over 4 weeks.
UCT is under copyright protection of Moxie GmbH (www.moxie-gmbh.de) and is free for routine clinical use and non-commercial research, has a small fee for use in clinical trials/commercial research.
1. Weller K, et al. J Allergy Clin Immunol. 2014;133(5):1365–1372;
2. The Urticaria Control Test (UCT). Available at: The Urticaria Control Test (UCT) | Chronic spontaneous urticaria | Commercial use | Our products | Moxie (moxie-gmbh.de);
3. Weller K, et al. J Eur Acad Dermatol Venereol. 2015;29(Suppl 3):38–44.4.
Dermatology life quality index (DLQI) assesses symptoms and impact on aspects of life
Dermatology life quality index (DLQI) is the first dermatology-specific patient-reported outcome (PRO) to assess health-related quality of life (HRQoL) and consists of 10 questions covering 6 domains 1-3. Each answer is given a score of 0–3 (0: the patient’s life is not affected in that domain, 3: the patient’s life if very much affected in that domain). Total scores are added up to give a final DLQI score (range 0–30) that assesses how much the patient’s HRQoL is affected. Higher scores indicate more impact on quality of life.
The authors of the DLQI were Professor A Y Finlay and Dr. G K Khan. By agreement, the Cardiff University (www.cardiff.ac.uk) now owns and administers all copyright matters relating to the DLQI. It may be used without seeking permission by clinicians for routine clinical purposes.
1. Weldon D. Allergy Asthma Proc. 2006;27:96‒9;
2. Both H, et al. J Invest Dermatol. 2007;127:2726‒39;
3. Cardiff University Department of Dermatology website. Available at: www.cardiff.ac.uk/dermatology/quality-of-life/dermatology-quality-of-life-index-dlqi
Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) is a chronic urticaria-specific health-related quality of life instrument
The CU-Q2oL patient questionnaire was designed and validated for the assessment of health-related quality of life (HRQoL) specifically in chronic urticaria, including the physical, psychosocial and practical aspects of this condition 1-2.
CU-Q2oL assesses 6 HRQoL categories over the previous 2 weeks associated with the disease: Pruritus (2 questions), Swelling (2 questions), Activities (6 questions), Sleep (5 questions), Limitations (3 questions) and Looks (5 questions).
The symptoms are given a score of 1–5.
The sum of the total of all scores is used to calculate a value from 0 to 100. A higher score indicates a poorer quality of life.
1. Baiardini I, et al. Allergy. 2011;66:840–4;
2. Baiardini I, et al. Allergy. 2005;60:1073–8.