Latest News and Info

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 (PROMs) in atopic dermatitis and chronic urticaria, highlighting findings from the international UCARE ADCARE PROMUSE study and the role of patient-centred allergy care.

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.

Urticaria Allergic rhinitis Mental health

9th April 2026

ACARE & UCARE Accredited Centre

Mind, Mucosa and Skin

How chronic urticaria, allergic rhinitis and psychological wellbeing can affect one another

At the London Allergy and Immunology Centre, we take a whole-person view of allergy care. New research highlights that chronic spontaneous urticaria, nasal allergy symptoms and emotional wellbeing are often closely connected. This matters because better understanding of this link can help patients access more complete and effective care.

The link between chronic urticaria hives, allergic rhinitis symptoms and psychological stress in allergy patients

The connection between chronic urticaria, allergic rhinitis and psychological stress affecting overall wellbeing.

Quick overview

What this means
What is CSU?
What the study found
Rhinitis link
Stress and skin
How we help

Why this matters for patients with allergy and urticaria

Chronic spontaneous urticaria, often called CSU, is more than a skin rash. It can disrupt sleep, affect confidence, interfere with work and family life, and create constant uncertainty because symptoms may flare without warning. When allergic rhinitis is also present, the burden can become even greater. Nasal blockage, sneezing, poor sleep and persistent irritation may add to fatigue and emotional strain.

A 2026 study explored this triad of mind, mucosa and skin and showed that psychiatric comorbidities were very common among adults with antihistamine-refractory CSU receiving omalizumab. The findings support a more integrated model of care in which allergy, skin symptoms, sleep and mental wellbeing are considered together rather than separately.

What is chronic spontaneous urticaria?

Urticaria is characterised by itchy raised wheals, angioedema, or both. When symptoms persist for more than 6 weeks, the condition is defined as chronic urticaria. If the rash and swelling occur without a clear external trigger, it is called chronic spontaneous urticaria.

Many patients improve with antihistamines, but some continue to have frequent symptoms despite treatment. In these more difficult cases, specialist assessment is important to confirm the diagnosis, identify associated conditions, assess disease activity properly and consider advanced treatment options such as omalizumab where appropriate.

Common features of CSU

– Recurrent itchy wheals
– Swelling of the lips, eyelids, hands or other areas
– Symptoms lasting longer than 6 weeks
– Unpredictable flare-ups
– Sleep disturbance and reduced quality of life

What did the 2026 study find?

The study reviewed 72 adults with antihistamine-refractory CSU who received omalizumab and had a formal psychiatric evaluation at a tertiary allergy centre between 2015 and 2025. Most participants were female, with a median age of 45 years. Psychiatric diagnoses were identified in 90.3% of the cohort who underwent psychiatric assessment.

The most frequent psychiatric diagnostic group was anxiety disorders, followed by mood disorders and sleep-wake disorders. Generalised anxiety disorder was the single most common diagnosis. The authors also reported that allergic rhinitis was present in more than half of the cohort, suggesting an important upper-airway allergic burden in this patient group.

Study finding	Result
Patients included	72 adults with antihistamine-refractory CSU treated with omalizumab
Female participants	70.8%
Median age	45 years
Any psychiatric comorbidity	90.3%
Most common psychiatric group	Anxiety disorders
Allergic rhinitis in the cohort	51.4%

Why allergic rhinitis may worsen the overall burden

Allergic rhinitis is sometimes seen as a minor condition, but persistent nasal symptoms can have a major effect on quality of life. Blocked nose, sneezing, post-nasal drip, poor sleep and daytime fatigue may all contribute to irritability, reduced concentration and lower resilience. In patients who also have chronic urticaria, this can intensify the sense of being unwell.

The authors of the study suggested that allergic rhinitis may reinforce the psychodermatological loop by adding sleep disruption and chronic upper-airway inflammation to an already stressful skin condition. This is one reason why it is important for specialist clinics to assess the whole allergic picture rather than looking at hives in isolation.

When urticaria and rhinitis coexist, patients may experience

– More sleep disturbance
– Greater tiredness during the day
– Higher stress levels
– Lower quality of life
– A stronger perception that symptoms are difficult to control

The stress-skin connection in chronic urticaria

Patients often tell us that stress seems to aggravate their hives. This fits with what clinicians and researchers have observed for many years. Chronic urticaria can itself be stressful because flare-ups are unpredictable and visible. At the same time, stress may influence inflammatory pathways, itch perception and symptom severity, which can then further increase anxiety and distress. This creates a self-perpetuating cycle.

The 2026 paper describes this as a close interaction between psyche and skin. Biological pathways thought to be involved include stress-related neuroimmune signalling and mast cell-mediated inflammation. For patients, the important message is simple: the symptoms are real, the burden is real, and both the physical and emotional impact deserve proper attention.

This does not mean urticaria is “just stress”. Rather, it means stress, sleep problems, allergy symptoms and inflammation may all affect one another. That is why good management often requires more than a prescription alone.

Response to treatment in the study

Under omalizumab treatment, disease control improved significantly in this cohort. Median UAS7 scores fell from 42 before treatment to 7 at 24 months, while UCT scores rose from 0 to 14. These results support the role of specialist treatment in patients whose symptoms remain poorly controlled on antihistamines alone.

The authors also noted that improving urticaria control may bring psychological benefits and better emotional wellbeing. In practice, this reinforces the importance of identifying uncontrolled disease early and ensuring that patients receive an expert review rather than simply repeating ineffective treatment.

What this means for care at our ACARE and UCARE accredited centre

As an ACARE and UCARE accredited centre, we believe patients with chronic urticaria deserve expert, evidence-based and compassionate care. This includes careful diagnosis, assessment of angioedema and inducible triggers, review of coexisting allergic diseases such as allergic rhinitis and asthma, and evaluation of how symptoms are affecting sleep, mood and daily functioning.

Where appropriate, management may involve optimisation of antihistamines, consideration of advanced treatment pathways, investigation of associated conditions and practical support around trigger awareness, sleep hygiene and stress reduction. In some cases, collaboration with other professionals may be helpful so that care is truly patient-centred and holistic.

For patients, the key message is that severe hives and swelling are not only skin symptoms. They can affect confidence, sleep, relationships and quality of life. Recognising that full burden is an important step towards better outcomes.

When to seek specialist urticaria assessment

– Your hives or swelling have lasted longer than 6 weeks
– Symptoms keep returning despite antihistamines
– You have troublesome angioedema
– Sleep is regularly disturbed by itch or nasal symptoms
– You feel that stress, anxiety or low mood are making symptoms harder to manage
– You may have both urticaria and allergic rhinitis

Book an expert review

If you are living with chronic hives, angioedema or allergic rhinitis, our specialist team can help assess the full picture and create a personalised plan. We offer consultant-led allergy care with a focus on accurate diagnosis, better symptom control and improved quality of life.

Book an appointment

Reference

This article is based on the 2026 paper by Zeynep Yegin Katran, İsmet Bulut, Andaç Salman, Ali Baz, Galip Muzaffer Kürşat Küçükali and Özge Argın, which examined the relationship between chronic spontaneous urticaria, allergic rhinitis and psychiatric comorbidities in omalizumab-treated adults.

Please note that this blog is for general education and does not replace personalised medical advice. Diagnosis and treatment should always be based on an individual clinical assessment.

Urticaria Day 2022: promoting a better quality of life

28th September 2022

Urticaria Day 2022: promoting a better quality of life

That time of year has come around again. Every year on the 1st of October, we raise awareness for Urticaria Day. By marking the occasion we want people to speak up about their life with the condition, and how we can make it an easier burden to bear.

This year is all about a “better quality of life”. While chronic urticaria is a physical condition, we don’t always pay attention to the effects it can have on our mental health. The focus of Urticaria Day 2022 is about how we can deal with the mental health challenges that arise and support those who need it.

If you’re not aware of urticaria and its far-reaching effects, we’re here to give you all the information you need.

What is urticaria?

Urticaria is a skin condition that you may also know as ‘hives’. You can notice it by its characteristic pale red weals that it leaves on the skin. It might not seem serious, but the intense itching that comes along with it can take a real toll on a person’s day.

This can be present on a specific part of the body for some, but for others it can spread across larger areas. And, while it can be acute and temporary, for many it is a chronic condition that flares up repeatedly. If you want to read more, we’ve talked about Urticaria Day in previous blogs, which you can find here, here, and here.

What is Urticaria Day 2022?

As we said before, this year’s theme is a “better quality of life”. Because even though it’s a skin condition, it can affect all aspects of a person’s life. As anyone living with the condition will attest to. They can compromise your ability to work, stop you from doing physical activity, or strain your relationships.

This is how it can affect a person’s mental health. People with chronic urticaria may feel isolated because their friends and family don’t understand. Or, by preventing someone from physical activity, it might stop them doing something they love. If the aim is to improve quality of life, then mental health has to be a part of the conversation.

The Urticaria Day website has some fantastic short videos that show just how chronic urticaria can affect our lives. From disturbing sleep to increasing anxiety, these videos are well worth showing someone who doesn’t understand how you feel.

What can you do?

The reason why Urticaria Day exists? To raise awareness. So if you want to do something to help, spread the word! There are a number of ways the organisers suggest you can help out. Why not look to see if there are any events in your local community? Just search “Urticaria Day” and your area and see what comes up. Take a look at social media, too.

Speaking of which, if you can’t take part in an event, you can still post about it on social media. The Urticaria Day organisers ask you to use the #UrticariaDay2022 and #UDAY2022 hashtags to join in with the conversation. Just showing that you’re paying attention can go a long way. And let your friends and family know all about it and how serious it can be.

For anyone suffering with acute or chronic urticaria, just know that you’re not alone. Urticaria Day 2022 is here to show you how much people care. If you’re ever concerned about your condition, talk to a skincare or allergy specialist to discuss the right course of treatment for you.

We’re a comforting shoulder for anyone with urticaria. We raise awareness about this condition every year because we acknowledge the effect it has on people. To discuss your urticaria, you can book an appointment with us, or simply give us a call on 02031 433 449.

The global impact of COVID-19 on chronic urticaria

28th April 2021

The global impact of COVID-19 on chronic urticaria

The COVID-19 pandemic disrupted almost everything. It’s affected schools, workplaces, shops, and even medical practices. But the impact of the pandemic on various health conditions like chronic urticaria (CU), which affects 50 million patients globally, is still largely unknown.

Common questions and concerns revolve around whether the treatments for CU can affect COVID, making patients more likely to contract it or worsen their symptoms. That’s why we conducted our own study to help shed some light on the impact of the pandemic on consultations, treatment, and changes in medication for patients with chronic urticaria.

What we did

We wanted to take stock of what other professionals experienced during the pandemic. A 17-item questionnaire was sent out to all 110 centres within the UCARE network. These questions focused on the most prevalent issues faced by urticaria specialists in this last year, and how this affected the care they could give.

Of the 110 surveys sent out, 95 responded.

How does COVID affect chronic urticaria?

First, let’s look at it on a physical level. With COVID-19 being a question mark for people with CU, we wanted to know if it adversely affected them. And that’s exactly what we found – COVID made CU symptoms worse for more than a third of patients. Those with severe COVID were more likely to have exacerbated CU symptoms compared to those with mild or moderate cases.

But does merely having CU make it more likely to contract the coronavirus. Our research shows that no, it doesn’t seem to increase the risk of sufferers developing a severe COVID reaction, even in patients on biological treatment (antihistamines, omalizumab). So while they aren’t more likely to catch it, there’s still a good enough reason to want to avoid it.

Chronic urticaria treatments and COVID

Next, we wanted to address how COVID affected CU treatment. Perhaps unsurprisingly, the pandemic made care for CU patients much harder to access, with almost half of the physicians in the study involved in COVID patient care, too. But with the study outlining how COVID can worsen CU symptoms, it’s clear that specialised urticaria centres are essential.

While the pandemic is making care harder to receive, it doesn’t have any significant effect on the use of first, second, and third-line treatments for CU. For example, antihistamine and omalizumab treatment continued as usual. Physicians agreed that antihistamines at the usual or higher doses are safe, even for patients with COVID-19.

In fact, antihistamines actually decreased the likelihood of fatality in patients with severe or critical lung COVID symptoms. And the same could be true for omalizumab, with 92.6% of physicians agreeing omalizumab is safe, too.

But only 24.2% agreed that immunosuppressive treatments (like cyclosporine) can be continued.

Our research shined a much-needed light on a condition that’s gone underappreciated during the pandemic. It highlights that we need to ensure those with CU still receive the treatment they need, and that safeguarding is of top priority. We were driven by our dedication to urticaria and always raise awareness of the condition for October 1st – National Chronic Urticaria Day.

Struggling with chronic urticaria? Regain control of your life. Allergy Clinic London has a team of experts who are dedicated to helping you get control of your symptoms. Call us now on 02031 433 449.