ArticleThe World Allergy Organization journal2026
Heterogeneity in clinical appearance of chronic spontaneous urticaria: A cross-sectional analysis of a retrospective cohort.
Article in The World Allergy Organization journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Aim: The study aimed to analyse the characteristics of subtypes of chronic spontaneous urticaria (CSU) and determine the factors that may influence treatment response. Methods: Clinical and laboratory characteristics of CSU patients were compared between 3 groups: (1) those with isolated urticaria (CSUwoAE, n = 50, 27.93%), (2) those with both urticaria and angioedema (CSUwAE, n = 86, 48.04%), and (3) those with isolated angioedema, also referred to as chronic histaminergic angioedema (CHA, n = 43, 24.02%). The Visual Analogue Scale for the worst attack (VAS-WA), Visual Analogue Scale for angioedema control (VAS-AEC), angioedema control test (AECT), Urticaria Control Test (UCT) and Angioedema Quality of Life (AEQoL) were the assessment tools. Results: A weak correlation was observed between disease onset age and BMI (r = 0.295, p < 0.001). The age of onset was higher in CHA than in CSUwAE (p < 0.001). Oropharyngeal angioedema was more frequent in CHA (p = 0.022), whereas eyelid angioedema occurred more often in CSUwAE (p = 0.001). CHA patients had more impaired AEQoL (p = 0.043) and poorer disease control per AECT and VAS-AEC (p < 0.001, p = 0.001, respectively). The rate of high-dose antihistamine response among patients with angioedema was lower in the CHA group (n = 1; 12.5%) compared with the CSUwAE group (n = 10; 66.7%; p = 0.027). Irrespective of CSU subtypes, omalizumab response varied by BMI in patients with angioedema (n = 51; p = 0.002), with the least response in obese patients (p = 0.033). Conclusion: Our study observed that obesity appeared to be associated with a later age of CSU onset and with a lower likelihood of omalizumab responsiveness in patients with angioedema; however, these findings should be interpreted as associations rather than suggesting any causal relationship. Additionally, CHA patients seem to have more severely impaired quality of life and a less controlled disease compared to CSUwAE.
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