The Overall Burden of Chronic Spontaneous Urticaria - The Current Landscape

Chronic spontaneous urticaria (CSU) is a mast cell-driven inflammatory disease characterized by recurrent wheals and/or angioedema with an unpredictable course and substantial global prevalence. Beyond its visible skin manifestations, CSU may impose a profound and multifaceted burden on patients, families, healthcare systems, and society. This narrative review synthesizes current evidence on the overall burden of CSU, encompassing epidemiology, clinical manifestations, humanistic impact, cumulative life course impairment, and economic costs. CSU markedly disrupts quality of life through sleep disturbance, pruritus, emotional distress, psychiatric comorbidity, impaired social and occupational functioning, and stigma, with effects extending to children, caregivers, and family members. Disease burden is further amplified by angioedema, concomitant inducible urticaria, delayed diagnosis, suboptimal treatment, and persistent uncertainty regarding disease recurrence, even during periods of symptom control. Indirect and direct economic costs-including healthcare utilization, absenteeism, and presenteeism-are substantial and vary across regions, influenced by healthcare systems and access to effective therapies. The review highlights the importance of comprehensive, patient-centred burden assessment using validated patient-reported outcome measures, alongside disease activity evaluation, to inform individualized management strategies. Addressing the hidden and cumulative burden of CSU requires timely diagnosis, personalized and phenotype-based treatment, integration of psychosocial care, and improved access to effective therapies in order to meaningfully restore quality of life and long-term well-being.