Chronic Urticaria: A Swedish Registry-based Cohort Study on Population, Comorbidities and Treatment Characteristics
Keywords:urticaria, chronic urticaria, therapeutics, adult, child, comorbidity, guideline, angioedema, dermatology
Swedish databases present unique opportunities to research population data on diseases and treatments. The current study is, to our knowledge, the most comprehensive registry-based study on a chronic urticaria population in Sweden to date. The aim of this study was to describe the chronic urticaria population in Stockholm County regarding epidemiology, demographics, comorbidity, healthcare usage and treatment patterns in relation to current international guidelines. Real-world data were extracted between 2013 and 2019, yielding 10,642 adult patients. Study period prevalence of chronic urticaria was 0.53%, the mean annual incidence was approximately 0.08%, and 68% of patients were female. Regarding diagnosis, 58% were first diagnosed in primary care, approximately 50% were diagnosed before the age of 40 years. Regarding type of urticaria, 89% had chronic spontaneous urticaria, 11% had chronic inducible urticaria, and 5% of patients with chronic urticaria had coexisting angioedema. Common coexisting diagnoses were, for example, asthma, allergy, psychiatric and behavioural disorders and cardiometabolic disorders. Treatment patterns generally followed guidelines, yet data indicated that guidelines were not fully implemented, especially in primary care.
Bolognia J, Schaffer JV, Cerroni L. Dermatology. 2018 [cited 2020 Sep 14]. Available from: https://www.clinicalkey.com/dura/browse/bookChapter/3-s2.0-C20131144449.
Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy 2018; 73: 1393-1414.
Fricke J, Ávila G, Keller T, Weller K, Lau S, Maurer M, et al. Prevalence of chronic urticaria in children and adults across the globe: systematic review with meta-analysis. Allergy 2020; 75: 423-432.
Dias GAC, Pires GV, do Valle SOR, Dortas Júnior SD, Levy S, França AT, et al. Impact of chronic urticaria on the quality of life of patients followed up at a university hospital. An Bras Dermatol 2016; 91: 754-759.
Itakura A, Tani Y, Kaneko N, Hide M. Impact of chronic urticaria on quality of life and work in Japan: results of a real-world study. J Dermatol 2018; 45: 963-970.
Konstantinou GN, Konstantinou GN. Psychiatric comorbidity in chronic urticaria patients: a systematic review and meta-analysis. Clinl Translat Allergy 2019; 9: 42.
Kolkhir P, Borzova E, Grattan C, Asero R, Pogorelov D, Maurer M. Autoimmune comorbidity in chronic spontaneous urticaria: a systematic review. Autoimmun Rev 2017; 16: 1196-1208.
Chang H-W, Cheng H-M, Yen H-R, Hsu CY, Lee Y-C, Chiang J-H, et al. Association between chronic idiopathic urticaria and hypertension: a population-based retrospective cohort study. Ann Allergy Asthma Immunol 2016; 116: 554-558.
Shalom G, Kridin K, Babaev M, Magen E, Tiosano S, Dreiher J, et al. Chronic urticaria and osteoporosis: a longitudinal, community-based cohort study of 11 944 patients. Br J Dermatol 2019; 180: 1077-1082.
Vadasz Z, Kessel A, Hershko AY, Maurer M, Toubi E. Seasonal exacerbation of asthma is frequently associated with recurrent episodes of acute urticaria. Int Arch Allergy Immunol 2016; 169: 263-266.
Kolkhir P, Pogorelov D, Darlenski R, Caminati M, Tanno LK, Le Pham D, et al. Management of chronic spontaneous urticaria: a worldwide perspective. World Allergy Organ J 2018; 11: 14.
Ferrer M, Jáuregui I, Bartra J, Dávila I, del Cuvillo A, Montoro J, et al. Chronic urticaria: do urticaria nonexperts implement treatment guidelines? A survey of adherence to published guidelines by nonexperts. Br J Dermatol 2009; 160: 823-827.
Stockholm County Healthcare Administration (Hälso- och sjukvårdsförvaltningen). VAL databaserna. 2017 [cited 2020 Sep 14]. Available from: http://www.gups.sll.se/val/Valhandbok_Kortversion.pdf.
Statistikdatabasen, Statistiska Centralbyrån. [cited 2020 Sep 22]. Available from: http://www.statistikdatabasen.scb.se/pxweb/sv/ssd/START__BE__BE0101__BE0101A/BefolkManad/.
R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; Available from: http://www.R-project.org/.
ICD-10 Version:2019. [cited 2020 Sep 14]. Available from: https://icd.who.int/browse10/2019/en.
Vena GA, Cassano N. The link between chronic spontaneous urticaria and metabolic syndrome. Eur Ann Allergy Clin Immunol 2017; 49: 208-212.
Hellgren L. The prevalence of urticaria in the total population. Acta Allergol 1972; 27: 236-240.
Zuberbier T, Balke M, Worm M, Edenharter G, Maurer M. Epidemiology of urticaria: a representative cross-sectional population survey. Clin Exp Dermatol 2010; 35: 869-873.
Thomsen SF, Pritzier EC, Anderson CD, Vaugelade-Baust N, Dodge R, Dahlborn A-K, et al. Chronic urticaria in the real-life clinical practice setting in Sweden, Norway and Denmark: baseline results from the non-interventional multicentre AWARE study. J Eur Acad Dermatol Venereol 2017; 31: 1048-1055.
Hon KL, Leung AKC, Ng WGG, Loo SK. Chronic urticaria: an overview of treatment and recent patents. Recent Pat Inflamm Allergy Drug Discov 2019; 13: 27-37.
Maltseva N, Borzova E, Fomina D, Bizjak M, Terhorst-Molawi D, Košnik M, et al. Cold urticaria - what we know and what we do not know. Allergy 2021; 76: 1077-1094.
Gaig P, Olona M, Muñoz Lejarazu D, Caballero MT, Domínguez FJ, Echechipia S, et al. Epidemiology of urticaria in Spain. J Investig Allergol Clin Immunol 2004; 14: 214-220.
Nebiolo F, Bergia R, Bommarito L, Bugiani M, Heffler E, Carosso A, et al. Effect of arterial hypertension on chronic urticaria duration. Ann Allergy Asthma Immunol 2009; 103: 407-410.
van der Valk PGM, Moret G, Kiemeney LALM. The natural history of chronic urticaria and angioedema in patients visiting a tertiary referral centre. Br J Dermatol 2002; 146: 110-113.
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Copyright (c) 2021 Mahsa Tayefi, Maria Bradley, Anders Neijber, Alexander Fastberg, Dylan Ceynowa, Margareta Eriksson
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