Patient-Reported Outcome Measures in Atopic Dermatitis and Chronic Urticaria: Why They Matter in Modern Allergy Care

6th June 2026

Patient-Reported Outcome Measures in Atopic Dermatitis and Chronic Urticaria: Why They Matter in Modern Allergy Care

The management of chronic allergic skin conditions is evolving rapidly. Increasingly, healthcare professionals recognise that understanding how patients feel and function in daily life is just as important as measuring clinical signs and laboratory results. Patient-reported outcome measures (PROMs) are helping bridge this gap by bringing the patient’s voice directly into clinical decision-making.

Patient-reported outcome measures help clinicians understand symptom burden, quality of life and treatment response in atopic dermatitis and chronic urticaria

What Are Patient-Reported Outcome Measures (PROMs)?

Patient-reported outcome measures (PROMs) are validated questionnaires completed by patients that assess symptoms, quality of life, treatment effectiveness and the overall impact of disease on everyday activities.

Unlike laboratory tests or physical examinations, PROMs capture the aspects of disease that only patients can truly describe. This is particularly important in conditions such as atopic dermatitis (eczema) and chronic urticaria (hives), where symptom severity, itching, sleep disruption and emotional wellbeing may fluctuate significantly between clinic visits.

PROMs help clinicians better understand the burden of disease, monitor treatment response and support shared decision-making between patients and healthcare professionals.

The PROMUSE Study: Understanding Why PROMs Are Underused

A landmark international study published in the World Allergy Organization Journal in 2026 investigated why PROMs remain underused in routine clinical practice despite their recognised value.

The PROMUSE study was conducted through the international UCARE (Urticaria Centres of Reference and Excellence) and ADCARE (Atopic Dermatitis Centres of Reference and Excellence) networks and involved physicians from specialised allergy and dermatology centres worldwide.

Importantly, Professor Michael Rudenko of the London Allergy and Immunology Centre was among the international co-authors contributing to this global collaboration examining the implementation of patient-centred outcome measures in allergic skin disease.

Key Findings

• Many clinicians recognise the value of PROMs but face practical barriers to implementation.
• Time constraints remain the most commonly reported challenge.
• Many physicians believe patients dislike completing questionnaires.
• Lack of integration into electronic health systems limits routine use.
• Some clinicians feel PROMs may interfere with the doctor-patient relationship.
• The greater the number of perceived barriers, the less likely physicians are to use PROMs regularly.

Interestingly, the study found that concerns regarding patient dissatisfaction and interference with clinical interactions were among the strongest factors associated with reduced PROM use.

Professor Michael Rudenko’s Clinical Perspective

As both a co-author of the PROMUSE study and a practising Consultant Allergist and Clinical Immunologist, I believe the findings highlight an important opportunity to improve patient-centred care in allergy and dermatology.

In everyday clinical practice, many patients experience symptoms that cannot be fully appreciated through examination alone. A patient with chronic urticaria may have minimal visible hives during a consultation but may have experienced severe symptoms throughout the preceding week. Similarly, a patient with atopic dermatitis may appear clinically improved while still suffering from significant itching, sleep disruption and reduced quality of life.

PROMs provide a structured way to capture these experiences and ensure they become part of the clinical conversation.

Importantly, PROMs should never replace clinical judgement or specialist assessment. Rather, they should complement traditional medical evaluation by helping clinicians understand the patient’s perspective more accurately.

The most effective PROMs are simple, relevant and easy to complete. They should focus on outcomes that matter most to patients while providing meaningful information that can guide treatment decisions.

Modern medicine is increasingly moving towards personalised and precision healthcare. In this context, understanding how a disease affects an individual’s daily life is becoming just as important as measuring objective disease activity.

Future developments are likely to include digital symptom tracking, integration with electronic health records, mobile health applications and more sophisticated patient-centred outcome measures developed with direct patient involvement.

Ultimately, successful allergy care requires both scientific expertise and a clear understanding of the patient’s lived experience. PROMs can help bridge that gap and support better outcomes for patients with chronic allergic diseases.

Professor Michael Rudenko MD PhD FAAAAI
Consultant Allergist and Clinical Immunologist
London Allergy and Immunology Centre

PROMs in Atopic Dermatitis

Atopic dermatitis affects millions of people worldwide and often causes substantial physical and psychological burden. Symptoms such as itching, sleep disturbance, skin pain, embarrassment and reduced self-confidence may significantly impact daily life.

PROMs help clinicians understand:

• Severity of itching
• Sleep quality
• Impact on work and school performance
• Emotional wellbeing
• Treatment satisfaction
• Long-term disease control

By incorporating patient-reported outcomes into routine care, clinicians can gain a more complete picture of disease burden and treatment effectiveness.

PROMs in Chronic Urticaria

Chronic urticaria is characterised by recurrent hives, swelling (angioedema) or both. Symptoms may fluctuate unpredictably and can have a major impact on quality of life.

Patient-reported outcome measures are particularly useful for:

• Assessing symptom control over time
• Evaluating treatment effectiveness
• Monitoring disease activity between visits
• Supporting treatment optimisation
• Identifying patients who require escalation of therapy

Several validated urticaria-specific questionnaires are now widely used in clinical research and specialist practice.

The Future of Patient-Centred Allergy Care

The future of allergy and dermatology care will increasingly focus on combining clinical expertise with patient-reported outcomes, digital health technologies and shared decision-making.

The PROMUSE study suggests that while barriers remain, clinicians and healthcare systems have an opportunity to redesign PROM implementation in a way that is both efficient and meaningful for patients.

Importantly, future PROM development should involve patients directly, ensuring that questionnaires reflect the outcomes that matter most to those living with allergic disease.

When Should You See an Allergy Specialist?

You may benefit from specialist assessment if you experience:

• Persistent eczema despite treatment
• Chronic hives lasting longer than six weeks
• Recurrent angioedema
• Sleep disturbance caused by skin symptoms
• Reduced quality of life due to allergic disease
• Uncertainty regarding diagnosis or treatment options

A specialist allergy assessment can help establish an accurate diagnosis, optimise treatment and identify factors contributing to persistent symptoms.

References

Cherrez-Ojeda I, Robles-Velasco K, Giménez-Arnau A, et al. Why physicians underuse patient-reported outcomes in atopic dermatitis and chronic urticaria: Insights from the UCARE/ADCARE PROMUSE study. World Allergy Organization Journal. 2026;19:101398.

Additional references available upon request.

Allergic skin conditions: what you need to know

14th December 2018

Allergic skin conditions: what you need to know

The skin is your largest organ, so you should take care of it as such. While we would all love healthy, clear skin, for some this is a near impossibility thanks to our allergies. Skin allergies can exacerbate conditions like urticaria or dermatitis. At their worst, they can also lead to asthmatic reactions, putting your life on the line. It’s estimated that 60% of us suffer from a skin condition.

Dealing with allergies is difficult enough, but when you suffer from a skin problem, it is incredibly challenging. But what are the most common conditions and what causes them?

Atopic dermatitis

Belonging to the same group as eczema, atopic dermatitis is an inflammatory skin disease. Although it is common during infancy and childhood, not all sufferers will grow out of it and will continue to deal with the condition throughout adulthood. It’s caused when the skin isn’t able to properly retain moisture, causing the skin to dry out and blister, crack, and bleed. The skin is itchy, hot, and inflamed.

Unlike urticaria, atopic dermatitis doesn’t clear up overnight and is often a lifelong affliction. Mainly because it is a genetic condition, something which separates it from the similar contact dermatitis. Family members suffering from an allergic condition can even pass it on to their children. Triggers typically include extreme cold or hot weather, and chemicals like those found in soaps, detergents, and cosmetics.

Urticaria

Sometimes referred to as hives, weals, or welts, urticaria can cause the skin to itch, red bumps to form, and inflammation to rise. It usually forms on patches of the skin, but it can spread further across the body. Although it usually clears after 24 hours, it can affect the skin for around six weeks. We call it ‘acute urticaria’.

It can also manifest in chronic urticaria which causes the condition to last over several years. High levels of histamine in the body are a primary cause of the condition. When histamine, as well as other chemicals, are released into the skin after exposure to allergens, the blood vessels open, causing the skin to become blotchy and inflamed.

If you experience any of the symptoms listed, we highly recommend that you get tested for allergies. By doing so, you will be able to start your journey to living an itch-free life. Find out what environmental or chemical triggers you might have.

If you think you might be suffering from allergies, why not order one of our home testing kits today? Find out once and for all what’s causing your skin to itch. Request an allergy test from us or visit our website.

World Allergy Week 2018: atopic dermatitis

25th April 2018

World Allergy Week 2018: atopic dermatitis

It’s officially World Allergy Week 2018, and this year the World Allergy Organization are focusing on raising awareness for atopic dermatitis, also known as eczema. We are going to aid them in this task by discussing what atopic dermatitis is, its effects, and its treatments.

What is it?

Atopic dermatitis is an inflammatory skin disease. It affects people of all ages but more commonly begins during infancy and childhood. Sometimes you can outgrow it before adulthood, but it can also last into adulthood or begin during adulthood.

Atopic dermatitis disrupts the skin’s ability to hold moisture. It makes it itchy and red, with small blisters or oozing. In its chronic form, the skin may appear darkened, dry and thick. These symptoms are very uncomfortable for people living with the condition. This includes up to 5-30% of children and 1-10% of adults globally.

The discomfort is only one effect of atopic dermatitis. The changes it makes to the skin can also cause problems with self-esteem and mental well-being. This is particularly worrying for those in vulnerable groups, like children. Also, proper ongoing treatment requires a lot of attention, time, and care which can be disruptive and annoying in people’s everyday lives.

Where does it come from?

So what causes atopic dermatitis? There are several factors at play here. It is the most common chronic skin condition and is often genetically transmitted. It can be triggered by temperature and humidity, harsh soaps and detergents, weather changes, stress, microbial infections, lack of sleep, and allergens. Atopic dermatitis as a reaction to a food allergen is most common in children. But other allergens like dust mites, animal dander, and inhalant allergens can also trigger it.

Most people who have atopic dermatitis have a family or personal history of allergies. It’s often one of the first signs of allergic hypersensitivity during the first months with other allergies likely to follow. These frequently include a food allergy, hay fever, or asthma. But if you catch the symptoms early in childhood, dermatologists and allergists may be able to prevent or modify the development of new allergies and the experience of existing ones.

Treatment

Even if you receive no preventative treatment, there are other treatments available for people with atopic dermatitis surrounding trigger avoidance, medications, and skin care. The use of these approaches will depend on the severity of the disease. Treatments may include topical corticosteroids, topical calcineurin inhibitors, immunosuppressants, antihistamines, phototherapy, biological therapy, oral corticosteroids, or bleach baths and triclosan washes.

The hope with these treatments is that they will reduce the negative impacts of atopic dermatitis on quality of life. It can be chronic, disturb your sleep, make you self-conscious, limit your daily activities, impact your relationships, and make you susceptible to infections and viruses. These effects combine to make day to day life challenging and less enjoyable. In this case, any potential treatments to avoid the problems atopic dermatitis causes are essential.

To get involved with World Allergy Week, connect with us on twitter @Allergy_London using the #WorldAllergyWeek tag and help spread awareness of atopic dermatitis. To make an appointment with one of our specialist consultants, book online today. London Allergy & Immunology Centre can provide you with comprehensive allergy tests and the best treatment for you.

Scratching the surface of eczema

3rd January 2018

Scratching the surface of eczema

Dry, sensitive, and itchy skin is no laughing matter. Sadly for the estimated 15 million sufferers in the UK alone, atopic dermatitis – that’s eczema to you and me – is incredibly common. This pesky inflammatory skin disease can be very uncomfortable to the host, making skin red raw, dry, cracked, and tender. It’s more likely to occur in children, with almost a third of youngsters having this irritating ailment. But it affects more than just our infants. Eczema can occur at any age.

By definition, atopic dermatitis is a chronic skin condition, meaning that it’s long-lasting and has a tendency to flare periodically. It also commonly accompanies other allergies, such as hay fever or asthma.

Contact dermatitis is a type of eczema triggered by direct contact with something an individual has an allergy; typically, this will be from chemicals, bathroom products, jewellery, make-up or materials used in construction. Usually, you see delayed reactions, which can range from flaring up in a matter of hours to several days.

As an example, you can consider certain washing detergents as irritants because they can damage the outer layer of skin. But in the case of contact allergy, the immune system that recognises the allergen as a threat will damage skin. It’s more likely to affect the face and hands because the skin is thinner.

Touchy feely

There have been conflicting theories about whether or not contact allergy is a common problem in sufferers of atopic dermatitis. Some believe that patients with atopic dermatitis were unlikely to also suffer from contact dermatitis. The British Journal of Dermatology recently conducted a systematic review to challenge this and get to the bottom of the debate.

They wanted to distinguish the truth in the importance of undertaking a patch test for the allergens for contact dermatitis when a patient already suffers from atopic dermatitis.

To test the theory, they examined 68 children that fell into either category of “with” or ”without” atopic dermatitis. They measured results when a child experienced a minimum of one positive patch test reaction. It affected 41.7% of the children “with” as well as 46.6% of children “without”. These results show that whether an individual suffers from atopic dermatitis or not, patch testing is still vital as you may miss allergens for allergic contact dermatitis.

If you are one of the 15 million people that find yourself suffering from itchy skin and want to find out more about how you improve your condition, please book an appointment with our consultants.