Original Articles: Systemic Allergic Disorders
The Urticaria Severity Score: a sensitive questionnaire/index for monitoring response to therapy in patients with chronic urticaria

https://doi.org/10.1016/S1081-1206(10)60120-2Get rights and content

Background

Despite the existence of numerous dermatology-specific quality-of-life questionnaires, there exists a need for a well-validated instrument to evaluate and monitor patients with chronic urticaria.

Objective

To develop and validate a novel chronic urticaria-specific questionnaire, the Urticaria Severity Score (USS).

Methods

The USS was developed with 12 questions and 7 response options per question included in the final questionnaire. The USS was pilot tested on 28 patients with symptomatic chronic urticaria, and a modified version was tested in 80 patients. In this latter group, the USS was compared with the previously validated Dermatology Life Quality Index (DLQI). Patients completed both questionnaires at baseline and at follow-up (median, 2 weeks). Spearman rank correlation tests were used to compare the USS with the DLQI. At a subsequent visit, 9 additional patients completed the USS to evaluate test-retest reliability.

Results

There was a positive correlation between the USS and DLQI at baseline (r = 0.64) and follow-up (r = 0.69). The test-retest reliability correlation for the USS was adequate (r = 0.96) (P = .001). The USS was more sensitive in detecting symptom improvement than the DLQI. The mean (SD) “raw score” change from baseline to follow-up for the USS was 9.95 (12.80), whereas the mean (SD) change from baseline to follow-up for the DLQI was 2.25 (4.87).

Conclusions

The USS is a valid and reliable instrument for monitoring urticaria severity. The USS is more sensitive than the DLQI for quantifying urticaria severity and may be more applicable in the evaluation of urticaria-specific treatment efficacy.

Section snippets

INTRODUCTION

Urticaria is a common skin condition, which is estimated to afflict 10% to 20% of the US population at some time in their life.1, 2 Chronic urticaria refers to the daily or almost daily presence of itchy wheals for at least 6 weeks.1 Chronic urticaria has been shown to have a significant impact on patients’ quality of life (QOL), including sleep disturbances, social isolation, altered emotions, and difficulties with activities of daily living.3, 4 The disability and reduced QOL in untreated

Participants and Background

Institutional review board approval was obtained from the Montefiore Medical Center, Bronx, New York, institutional review board. Study participants were men or women 18 years or older who were willing to grant informed consent. These individuals were recruited from the outpatient clinical services of the Division of Allergy/Immunology of the Albert Einstein/Montefiore Medical Center with inclusion criteria as follows: aged 18 years or older and diagnosed as having chronic urticaria, which was

Sample Characteristics

The main patient sample included 80 patients (21 men and 59 women) whose mean (SD) age was 42.8 (16.2) years; their mean (SD) urticaria duration was 4.22 (6.76) years (data not shown). All patients who were approached agreed to participate, and all forms were fully completed.

Correlation Between the USS and the Previously Validated DLQI

Among our 80-patient sample, the USS and DLQI were administered at baseline and follow-up. The mean (SD) time to follow-up was 1.80 (6.76) weeks (range, 1-4 weeks). The mean (SD) USS scores were 35.4 (13.9) (range, 8-78) at

DISCUSSION

The QOL measures play key roles within the realms of direct patient care, clinical research, and health-related economics.14 The QOL assessments may be used to evaluate treatment effectiveness and can also be applied to routinely monitor patients with a particular disease state. The QOL scores may also serve as patient-centered outcome measures in the setting of a research trial. Along these lines, QOL outcomes can highlight the disability from a given disease and guide appropriate resource

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Disclosures: Authors have nothing to disclose.

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