BACKGROUND: Chronic spontaneous urticaria (CSU) patients frequently experience angioedema, with or without wheals. The real-world rate of these subtypes of CSU among patients and the clinical characteristics of these two populations is currently unclear.
METHOD: Here, we analysed CSU patients with angioedema, with (A+/W+) or without wheals (A+/W-), from Europe and Central/South America enrolled in the observational AWARE study. CSU patients were aged 18 years or older and refractory to at least one course of H1-antihistamine treatment. The two patient populations were compared on demographics, disease characteristics, disease control (Urticaria Control Test [UCT]; scores below 12 indicate poor control), quality of life impairment (Dermatology Life Quality Index [DLQI] and the Angioedema Quality of Life Questionnaire [AE-QoL]), and their use of health care resources.
RESULTS: Of the 4,174 AWARE patients assessed, 1,971 (47.2%) had CSU with angioedema, of which 95.9% had A+/W+ and 4.1% had A+/W-. The two groups were demographically similar, but a slightly larger proportion of A+/W- patients were 65 years or older compared to A+/W+ patients (19% vs. 11%). A+/W - patients had somewhat longer disease duration (6.2 vs. 5.0 years), longer average duration of angioedema episodes (3.6 vs. 2.5 days), and somewhat greater intensity of angioedema (moderate: 46% vs. 44%; severe: 31% vs. 22%). Disease control (UCT <12: 74% and 79%) and AE-QoL scores (41.9 [19.8] and 45.7 [24.2]) were similar in both populations, but A+/W- patients had lower DLQI scores (5.5 [6.2] vs. 8.9 [7.4]). Emergency room visits were less common among A+/W- patients (36% vs. 42%); visits to a general practitioner were more common (69% vs. 58%). Both groups showed similar visit patterns to pharmacies (both 25%), hospitals (30% and 26%), specialised urticaria centres (both 32%), and dermatologists or allergist specialists (58% and 53%).
CONCLUSION: CSU is associated with a high frequency of angioedema. Such patients with and without wheals are largely similar in most aspects including high rates of poor disease control. Further studies in larger CSU angioedema only patient populations are needed to better understand this CSU subtype.
