DETERMINANTS OF DISEASE SEVERITY AND QUALITY OF LIFE IN CHRONIC URTICARIA: A COMPARATIVE OBSERVATIONAL STUDY

Abstract

Background: Chronic urticaria (CU) is a persistent inflammatory skin disorder characterized by recurrent wheals, angioedema, or both lasting longer than six weeks. Although disease activity is commonly assessed using validated scoring systems, the clinical determinants of severe disease and quality-of-life impairment remain incompletely defined. Objective: To evaluate the clinical determinants of disease severity and quality-of-life impairment in patients with chronic urticaria. Methods: This analytical cross-sectional study included 120 adult patients with chronic urticaria attending a tertiary care dermatology center between October 2024 and October 2025. Disease activity was assessed using the Urticaria Activity Score over seven days (UAS7), and quality of life was evaluated using the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL). Associations between clinical variables and severe disease (UAS7 ≥28) were analyzed using chi-square tests and multivariate logistic regression. Determinants of quality-of-life impairment were assessed using multivariate linear regression. Results: The mean age of participants was 34.6 ± 11.2 years, and 56.7% were female. Severe disease was observed in 33.3% of patients. Angioedema (χ² = 8.72, p = 0.003) and refractoriness to regular-dose antihistamines (χ² = 15.84, p < 0.001) were significantly associated with severe disease. In multivariate analysis, refractoriness (aOR 3.12, 95% CI 1.41–6.89, p = 0.004) and angioedema (aOR 2.48, 95% CI 1.12–5.47, p = 0.020) independently predicted severe disease. Disease activity strongly correlated with quality-of-life impairment (r = 0.69, p < 0.001). UAS7 independently predicted CU-Q2oL scores (β = 0.58, p < 0.001), with the regression model explaining 52% of variance (adjusted R² = 0.52). Conclusion: Refractoriness to antihistamines and the presence of angioedema are key determinants of severe chronic urticaria. Disease activity remains the principal driver of quality-of-life impairment. Early identification of high-risk patients and comprehensive severity assessment are essential for optimizing management strategies.