Chronic spontaneous urticaria (CSU) is characterised by recurrent wheals (hives) and/or angioedema for>6-weeks. Some patients may have extracutaneous systemic symptoms during episodes of wheals and/or angioedema.

Here, we describe the prevalence and characteristics of systemic symptoms among CSU patients during worsening episodes as reported in the Urticaria Voices study.

Urticaria Voices, a multinational cross-sectional study, assessed the overall burden and management of CSU in adult patients undergoing physician-prescribed treatments. Patients completed an online survey comprising of questions on cutaneous and extracutaneous systemic symptoms, disease-severity (as reported by their physician) and treatments. Data were analyzed using descriptive statistics.

Overall, 582 CSU patients (women, 62%; age, mean [SD], 42.2 [11.9] years; 79% currently on H1-antihistamines; 43% with angioedema in past 12-months) participated in the study. In the previous 4 weeks, 47% of patients reported a physician assessment during which disease activity was reported as mild (16%), moderate (49%), severe (18%), very severe (11%) and not known/no symptoms (6%). In addition to the core CSU symptoms (itch, hives, angioedema), difficulty in sleeping (62%), pain (55%) and fatigue (49%) were the most frequent patient-reported physical symptoms during CSU-worsening. Most patients reported pain at the location of hives (58%), angioedema (33%), and joints (36%) during episodes of disease worsening. Less frequent symptoms included flushing, headache, and gastrointestinal symptoms.

This study shows that patients experience extracutaneous symptoms beyond itch, hives and/or angioedema during CSU worsening, which suggests a high physical impact. New therapies that offer sustained relief from CSU exacerbations are needed.