Treatment Guideline Chart
Urticaria is characterized by the appearance of wheals (hives) and/or angioedema.
The intensity of the pruritus varies but may be severe enough to disrupt sleep, work or school.
It is classified acute if the urticaria has been present for ≤6 weeks and chronic if >6 weeks. It can be spontaneous (no definite triggering factor) or inducible (a specific definite triggering factor is identified).
It can be triggered by immunological or non-immunological mechanism.

Urticaria Management

Follow Up

  • Patients should be assessed for disease activity, impact, and control at every follow-up visit using validated patient-reported outcome measures (PROMs) (eg Urticaria Activity Score [UAS], 7-day UAS [UAS7], Angioedema Activity Score [AAS], Chronic Urticaria Quality of Life questionnaire [CU-Q2oL], Angioedema-specific Quality of Life tool [AE-QoL], Urticaria Control Test [UCT], Angioedema Control Test [AECT])
  • Recommended tools to monitor disease activity in patients with chronic spontaneous urticaria:
    • Patients with angioedema, with or without wheals: AAS
    • Patients with wheals and angioedema: Both UAS7 and AAS
  • Recommended tools to assess disease control based on symptoms:
    • Patients with wheals, with or without angioedema: UCT
      • CU-Q2oL may also be used
    • Patients with angioedema, with or without wheals: AECT
      • AE-QoL may also be used
    • Patients with wheals and angioedema: Both UCT and AECT
      • CU-Q2oL and AE-QoL may also be used

Disease Control of Chronic Urticaria

Complete Control

  • Absence of signs or symptoms of the disease during treatment
  • PROMs: UAS7 = 0; UCT = 16; angioedema absent (AAS7/8 = 0); optimal quality of life (dermatology life quality index [DLQI] = 0-1)

Good Control

  • Decrease in symptoms or signs during treatment at an appropriate level as concluded by both the physician and the patient
  • PROMs: UAS7 = 1-6; UCT = ≥12; angioedema present (AAS7/8 = >0); good quality of life (DLQI = 2-5)

Partial Control

  • Decrease in the intensity of the symptoms or signs while treatment is ongoing, but adequate level has not been achieved yet based on the physician and the patient's assessment, and normal quality of life has not been achieved yet
  • PROMs: UAS7 = >6; UCT = <12; angioedema present (AAS7/8 = >0); with significant impact on quality of life (DLQI = >5)

Absence of Control

  • Absence of evident positive changes in the symptoms and quality of life of the patient after treatment initiation
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