Diagnostic Delay in Patients With Chronic Urticaria: Results From the Chronic Urticaria Registry (CURE)

Melba Muñoz^{1

2}, Pascale Salameh^{1

2

3

4

5

6}, Magdalena Zajac⁷, Daria Fomina^{8

9

10}, Elena Kovalkova⁸, Elena Bobrikova⁸, Gerelma Andrenova⁸, Alicja Kasperksa-Zajac⁷, Felix Aulenbacher^{1

2}, Leonie Shirin Herzog^{1

2}, Eva Maria Grekowitz^{1

2}, Thomas Buttgereit^{1

2}, Ana M Giménez-Arnau¹¹, Nidia Planella-Fontanillas¹¹, David Pesque¹¹, Maria Puertolas¹¹, Kanokvalai Kulthanan¹², Papapit Tuchinda¹², Mojca Bizjak^{13

14}, Mitja Košnik^{13

14}, Maryam Khoshkhui¹⁵, Farahzad Jabbari Azad¹⁵, Raisa Meshkova¹⁶, Sergey Savchenko¹⁶, Michael Makris¹⁷, Niki Papapostolou¹⁷, Jonny G Peter^{18

19}, Cascia Day^{18

19}, Cathryn McDougall^{18

19}, Mohamed Abuzakouk²⁰, Laurence Bouillet²¹, Andrea Bauer²², Claudio Alberto Salvador Parisi²³, Stamatios Gregoriou²⁴, Petra Staubach-Renz²⁵, Joachim Dissemond²⁶, Emek Kocatürk^{1

2

27}, Martijn B A van Doorn^{28

29}, Riccardo Asero³⁰, Clive Grattan³¹, Simon Francis Thomsen^{32

33}, Aurélie Du-Thanh³⁴, Yana Hackler³⁵, Karsten Weller^{1

2}, Pavel Kolkhir^{1

2}

Affiliations

¹ Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
² Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany.
³ School of Medicine, Lebanese American University, Byblos, Lebanon.
⁴ Institut National de Santé Publique d'Épidémiologie Clinique et de Toxicologie-Liban (INSPECT-LB), Beirut, Lebanon.
⁵ Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus.
⁶ Faculty of Pharmacy, Lebanese University, Hadat, Lebanon.
⁷ European Center for Diagnosis and Treatment of Urticaria, Medical University of Silesia, Katowice, Poland.
⁸ Moscow Research and Clinical Center of Allergy and Immunology, City Clinical Hospital 52, Moscow Healthcare Department, Moscow, Russian Federation.
⁹ Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
¹⁰ Department of Pulmonology, Astana Medical University, Astana, Kazakhstan.
¹¹ Department of Dermatology, Hospital del Mar Research Institute, Universitat Pompeu Fabra, Barcelona, Spain.
¹² Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹³ Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
¹⁴ Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
¹⁵ Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
¹⁶ Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk, Russian Federation.
¹⁷ Allergy Unit "D. Kalogeromitros", 2nd Department, Dermatology and Venereology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece.
¹⁸ Allergy and Immunology Unit, UCT Lung Institute, Cape Town, South Africa.
¹⁹ Division of Allergy and Clinical Immunology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
²⁰ Allergy & Immunology Department, Cleveland Clinic AbuDhabi, Abu Dhabi, UAE.
²¹ French National Reference Center, CREAK, Department of Internal Medicine and Clinical Immunology, CHU Grenobles Alpes, Grenoble, France.
²² Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
²³ Adults and Pediatric Allergy Sections, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
²⁴ National and Kapodistrian University of Athens, 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Athens, Greece.
²⁵ Department of Dermatology, University Medical Center Mainz, Mainz, Germany.
²⁶ Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany.
²⁷ Bahçeşehir University School of Medicine, Department of Dermatology, Istanbul, Turkey.
²⁸ Department of Dermatology, Erasmus MC, Rotterdam, the Netherlands.
²⁹ Centre for Human Drug Research, Leiden, the Netherlands.
³⁰ Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Milan, Italy.
³¹ Guy's Hospital, St John's Institute of Dermatology, London, UK.
³² Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.
³³ Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
³⁴ University and University Hospital of Montpellier, Montpellier, France.
³⁵ UNEV gGmbH, Berlin, Germany.

PMID: 41532284
DOI: 10.1111/cea.70215

Diagnostic Delay in Patients With Chronic Urticaria: Results From the Chronic Urticaria Registry (CURE)

Melba Muñoz et al. Clin Exp Allergy. 2026.

. 2026 Jan 14.

doi: 10.1111/cea.70215. Online ahead of print.

Authors

Affiliations

¹ Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
² Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany.
³ School of Medicine, Lebanese American University, Byblos, Lebanon.
⁴ Institut National de Santé Publique d'Épidémiologie Clinique et de Toxicologie-Liban (INSPECT-LB), Beirut, Lebanon.
⁵ Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus.
⁶ Faculty of Pharmacy, Lebanese University, Hadat, Lebanon.
⁷ European Center for Diagnosis and Treatment of Urticaria, Medical University of Silesia, Katowice, Poland.
⁸ Moscow Research and Clinical Center of Allergy and Immunology, City Clinical Hospital 52, Moscow Healthcare Department, Moscow, Russian Federation.
⁹ Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
¹⁰ Department of Pulmonology, Astana Medical University, Astana, Kazakhstan.
¹¹ Department of Dermatology, Hospital del Mar Research Institute, Universitat Pompeu Fabra, Barcelona, Spain.
¹² Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹³ Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
¹⁴ Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
¹⁵ Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
¹⁶ Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk, Russian Federation.
¹⁷ Allergy Unit "D. Kalogeromitros", 2nd Department, Dermatology and Venereology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece.
¹⁸ Allergy and Immunology Unit, UCT Lung Institute, Cape Town, South Africa.
¹⁹ Division of Allergy and Clinical Immunology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
²⁰ Allergy & Immunology Department, Cleveland Clinic AbuDhabi, Abu Dhabi, UAE.
²¹ French National Reference Center, CREAK, Department of Internal Medicine and Clinical Immunology, CHU Grenobles Alpes, Grenoble, France.
²² Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
²³ Adults and Pediatric Allergy Sections, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
²⁴ National and Kapodistrian University of Athens, 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Athens, Greece.
²⁵ Department of Dermatology, University Medical Center Mainz, Mainz, Germany.
²⁶ Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany.
²⁷ Bahçeşehir University School of Medicine, Department of Dermatology, Istanbul, Turkey.
²⁸ Department of Dermatology, Erasmus MC, Rotterdam, the Netherlands.
²⁹ Centre for Human Drug Research, Leiden, the Netherlands.
³⁰ Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Milan, Italy.
³¹ Guy's Hospital, St John's Institute of Dermatology, London, UK.
³² Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.
³³ Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
³⁴ University and University Hospital of Montpellier, Montpellier, France.
³⁵ UNEV gGmbH, Berlin, Germany.

PMID: 41532284
DOI: 10.1111/cea.70215

Abstract

Background: Chronic urticaria (CU) diagnosis includes the patient's clinical history and physical examination. However, atypical presentations or misdiagnosis can lead to diagnostic delay (DD).

Objective: The impact and contributing factors of DD in CU are unknown and were assessed in the present study.

Methods: We retrospectively analysed data from CU adult patients from the international, multicenter Chronic Urticaria Registry (CURE).

Results: Of 4332 CU patients, 61% had standalone chronic spontaneous urticaria (sCSU), 18% had ≥ 1 form of chronic inducible urticaria (CIndU), and 21% had a combination of both (CSU + CIndU). Diagnosis of CU was delayed in 24% of patients by at least 1 year. CIndU patients showed a longer DD compared to those with sCSU or CSU + CIndU (median, [IQR]: 4, [0-22] vs. 1, [0-6] vs. 2, [0-9] months, p < 0.001). Among CIndU patients, symptomatic dermographism (n = 264) and cholinergic urticaria (n = 103) patients had the longest DD compared to all other CIndU subgroups (median: 4 months, p = 0.005 for both). In CIndU patients, a longer DD was associated with having an additional CIndU (OR: 12.8, p = 0.03), younger age, comorbidities, lower disease control, and lack of second-generation H₁-antihistamine treatment. In CSU patients, a DD of ≥ 6 months was associated with lower CSU activity (median weekly Urticaria Activity Score of 14 vs. 21, p = 0.02) compared to that of DD < 6 months.

Conclusions: Diagnosis of CU is delayed in one out of four patients. Greater awareness of the guideline-recommended CU classification, clinical presentation, and diagnostic work-up can facilitate CU diagnosis.

Keywords: CURE; burden; chronic inducible urticaria; chronic spontaneous urticaria; chronic urticaria; diagnosis; diagnostic delay; registry.

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References

1. P. Kolkhir, A. M. Giménez‐Arnau, K. Kulthanan, J. Peter, M. Metz, and M. Maurer, “Urticaria,” Nature Reviews. Disease Primers 8, no. 1 (2022): 61.
1. T. Zuberbier, A. H. Abdul Latiff, M. Abuzakouk, et al., “The International EAACI/GA2LEN/EuroGuiDerm/APAAACI Guideline for the Definition, Classification, Diagnosis, and Management of Urticaria,” Allergy 77, no. 3 (2022): 734–766.
1. M. Munoz, L. A. Kiefer, M. P. Pereira, M. Bizjak, and M. Maurer, “New Insights Into Chronic Inducible Urticaria,” Current Allergy and Asthma Reports 24, no. 8 (2024): 457–469.
1. B. Torabi and M. Ben‐Shoshan, “The Association of Cholinergic and Cold‐Induced Urticaria: Diagnosis and Management,” BMJ Case Reports 2015 (2015): bcr2014205258.
1. M. M. Balp, K. Weller, V. Carboni, et al., “Prevalence and Clinical Characteristics of Chronic Spontaneous Urticaria in Pediatric Patients,” Pediatric Allergy and Immunology 29, no. 6 (2018): 630–636.

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Diagnostic Delay in Patients With Chronic Urticaria: Results From the Chronic Urticaria Registry (CURE)

Affiliations

Diagnostic Delay in Patients With Chronic Urticaria: Results From the Chronic Urticaria Registry (CURE)

Authors

Affiliations

Abstract

References

LinkOut - more resources

Full Text Sources