Antihistamine-resistant chronic spontaneous urticaria: 1-year data from the AWARE study

Area of Science:

• Dermatology
• Clinical Practice Research
• Urticaria Management

Background:

• Previous reports indicate undertreatment and poor guideline adherence in chronic spontaneous urticaria (CSU).
• Despite improved awareness, the impact on clinical management remains unclear.

Purpose of the Study:

• To describe disease burden, quality of life (QoL), and treatment patterns in H1-antihistamine-refractory CSU patients in Germany.
• To evaluate real-world management of CSU in Germany.

Main Methods:

• The study utilized data from the World-wide Antihistamine-Refractory chronic urticaria (CU) patient Evaluation (AWARE) study in Germany.
• Included were 1032 patients (18-75 years) with H1-antihistamine-refractory CSU for ≥2 months.
• Assessed disease characteristics, treatments, and QoL using DLQI, CU-QoL, and Angioedema QoL questionnaires.

Main Results:

• After 1 year, 42.2% of CSU patients remained uncontrolled (UCT score <12).
• Quality of life impairment remained high, with 28.2% reporting a significant impact on DLQI.
• Most patients did not receive guideline-recommended treatments; omalizumab use increased from 8.5% to 21.4%, but only 5% of eligible patients were initiated on it.

Conclusions:

• A significant discrepancy exists between international CSU management guidelines and real-world clinical practice in Germany.
• Undertreatment and suboptimal adherence to guideline recommendations persist in CSU management.
• There is a need to improve the implementation of evidence-based CSU treatments in clinical practice.