Physician estimation of the prevalence and clinical impact of chronic urticaria: results of the global, multicenter UCARE CU-PAPER study

Introduction: Chronic urticaria (CU) is a common, burdensome mast cell-mediated skin disease. However, little is known about physician estimation of the disease prevalence and clinical impact. This study assessed physicians’ perceptions of CU and compared them with data from peer-reviewed literature. Methods: We conducted a cross-sectional, questionnaire-based study distributed worldwide via UCARE (Urticaria Centers of Reference and Excellence) network to 198 UCAREs and forwarded to GPs (general practitioners). Questionnaire data was analyzed using SPSS and subgroup analysis was performed using appropriate non-parametric statistical tests depending on the number of comparison groups and the distribution of the data. Results: In total, 234 participants from 46 countries completed the survey [54.3% female, median age: 48.5, interquartile range (IQR) 38.3–58.0 years]. Median age of disease onset reported for chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU) was 30.0 and 25.0 years, respectively. Median estimated prevalence of CU in adult and pediatric patients was 2.5% and 1.0%, respectively. The most affected aspects of patient life, estimated by physicians, were sleep (CSU), physical activities (CIndU), and mental status (CSU, CIndU). Physicians working at UCARE (78.9% (183/232) vs. non-UCARE (21.1% (49/232) sites differed in their estimation of adult CU prevalence (median: 2.0% vs. 4.5%, p < 0.001), proportion of adult CSU patients among CU patients (median: 70.0% vs. 60.0%, p = 0.027), and proportion of CSU patients with severe impact (median: 50.0% vs. 30.0%, p = 0.042). When asked how confident participants were in their estimations regarding CU prevalence and burden, UCARE experts reported significantly higher median confidence compared to other physicians. Conclusion: Although physicians’ estimations of CU prevalence and burden generally align with literature data, non-UCARE physicians may underestimate the burden and overestimate the prevalence. This might affect CU management in primary care potentially leading to a less effective treatment and underscores the need for increased urticaria awareness among non-UCARE physicians via publications, masterclasses, webinars, or other educational initiatives.