TY - JOUR
T1 - Diagnostic Delay in Patients With Chronic Urticaria
T2 - Results From the Chronic Urticaria Registry (CURE)
AU - Muñoz, Melba
AU - Salameh, Pascale
AU - Zajac, Magdalena
AU - Fomina, Daria
AU - Kovalkova, Elena
AU - Bobrikova, Elena
AU - Andrenova, Gerelma
AU - Kasperska-Zając, Alicja
AU - Aulenbacher, Felix
AU - Herzog, Leonie Shirin
AU - Grekowitz, Eva Maria
AU - Buttgereit, Thomas
AU - Giménez-Arnau, Ana M.
AU - Planella-Fontanillas, Nidia
AU - Pesque, David
AU - Puertolas, Maria
AU - Kulthanan, Kanokvalai
AU - Tuchinda, Papapit
AU - Bizjak, Mojca
AU - Košnik, Mitja
AU - Khoshkhui, Maryam
AU - Azad, Farahzad Jabbari
AU - Meshkova, Raisa
AU - Savchenko, Sergey
AU - Makris, Michael
AU - Papapostolou, Niki
AU - Peter, Jonny G.
AU - Day, Cascia
AU - McDougall, Cathryn
AU - Abuzakouk, Mohamed
AU - Bouillet, Laurence
AU - Bauer, Andrea
AU - Parisi, Claudio Alberto Salvador
AU - Gregoriou, Stamatios
AU - Staubach-Renz, Petra
AU - Dissemond, Joachim
AU - Kocatürk, Emek
AU - van Doorn, Martijn B.A.
AU - Asero, Riccardo
AU - Grattan, Clive
AU - Thomsen, Simon Francis
AU - Du-Thanh, Aurélie
AU - Hackler, Yana
AU - Weller, Karsten
AU - Kolkhir, Pavel
N1 - Publisher Copyright:
© 2026 John Wiley & Sons Ltd.
PY - 2026/4
Y1 - 2026/4
N2 - Background: Chronic urticaria (CU) diagnosis includes the patient's clinical history and physical examination. However, atypical presentations or misdiagnosis can lead to diagnostic delay (DD). Objective: The impact and contributing factors of DD in CU are unknown and were assessed in the present study. Methods: We retrospectively analysed data from CU adult patients from the international, multicenter Chronic Urticaria Registry (CURE). Results: Of 4332 CU patients, 61% had standalone chronic spontaneous urticaria (sCSU), 18% had ≥ 1 form of chronic inducible urticaria (CIndU), and 21% had a combination of both (CSU + CIndU). Diagnosis of CU was delayed in 24% of patients by at least 1 year. CIndU patients showed a longer DD compared to those with sCSU or CSU + CIndU (median, [IQR]: 4, [0–22] vs. 1, [0–6] vs. 2, [0–9] months, p < 0.001). Among CIndU patients, symptomatic dermographism (n = 264) and cholinergic urticaria (n = 103) patients had the longest DD compared to all other CIndU subgroups (median: 4 months, p = 0.005 for both). In CIndU patients, a longer DD was associated with having an additional CIndU (OR: 12.8, p = 0.03), younger age, comorbidities, lower disease control, and lack of second-generation H1-antihistamine treatment. In CSU patients, a DD of ≥ 6 months was associated with lower CSU activity (median weekly Urticaria Activity Score of 14 vs. 21, p = 0.02) compared to that of DD < 6 months. Conclusions: Diagnosis of CU is delayed in one out of four patients. Greater awareness of the guideline-recommended CU classification, clinical presentation, and diagnostic work-up can facilitate CU diagnosis.
AB - Background: Chronic urticaria (CU) diagnosis includes the patient's clinical history and physical examination. However, atypical presentations or misdiagnosis can lead to diagnostic delay (DD). Objective: The impact and contributing factors of DD in CU are unknown and were assessed in the present study. Methods: We retrospectively analysed data from CU adult patients from the international, multicenter Chronic Urticaria Registry (CURE). Results: Of 4332 CU patients, 61% had standalone chronic spontaneous urticaria (sCSU), 18% had ≥ 1 form of chronic inducible urticaria (CIndU), and 21% had a combination of both (CSU + CIndU). Diagnosis of CU was delayed in 24% of patients by at least 1 year. CIndU patients showed a longer DD compared to those with sCSU or CSU + CIndU (median, [IQR]: 4, [0–22] vs. 1, [0–6] vs. 2, [0–9] months, p < 0.001). Among CIndU patients, symptomatic dermographism (n = 264) and cholinergic urticaria (n = 103) patients had the longest DD compared to all other CIndU subgroups (median: 4 months, p = 0.005 for both). In CIndU patients, a longer DD was associated with having an additional CIndU (OR: 12.8, p = 0.03), younger age, comorbidities, lower disease control, and lack of second-generation H1-antihistamine treatment. In CSU patients, a DD of ≥ 6 months was associated with lower CSU activity (median weekly Urticaria Activity Score of 14 vs. 21, p = 0.02) compared to that of DD < 6 months. Conclusions: Diagnosis of CU is delayed in one out of four patients. Greater awareness of the guideline-recommended CU classification, clinical presentation, and diagnostic work-up can facilitate CU diagnosis.
KW - CURE
KW - burden
KW - chronic inducible urticaria
KW - chronic spontaneous urticaria
KW - chronic urticaria
KW - diagnosis
KW - diagnostic delay
KW - registry
UR - https://www.scopus.com/pages/publications/105027653511
U2 - 10.1111/cea.70215
DO - 10.1111/cea.70215
M3 - Article
C2 - 41532284
AN - SCOPUS:105027653511
SN - 0954-7894
VL - 56
SP - 411
EP - 420
JO - Clinical and Experimental Allergy
JF - Clinical and Experimental Allergy
IS - 4
ER -