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 and you

14th December 2017

Urticaria and you

Urticaria might sound like an abandoned Tolkien character, but it’s actually a lot more familiar than that. More commonly known as hives, urticaria is the medical name for the pale red bumps that appear on the skin, often as a reaction to certain allergens, though they can also occur because of the cold or unknown reasons. In most cases, they class this condition as ‘acute’. That is, provoked as a temporary reaction to a one-time stimulus. But it can also manifest as ‘chronic’, lasting over long periods of time for a few different reasons, usually linked to autoimmune reactions and infections.

Today we’re going to be mainly focusing on the short-term, acute cases of urticaria. Much of what we discuss is also useful for chronic sufferers and can help alleviate symptoms all the same. Urticaria can be a symptom of an allergic reaction; food allergies, allergy to the venom of stinging insects, reactions to medication, latex allergies. When urticaria rears its head it requires assessment by a specialist as the condition might be dangerous or even life-threatening.

The facts

Spontaneous urticaria can be induced by a variety of physical triggers, such as temperature change, pressure or even exercise. It’s usually not dangerous but very uncomfortable as it can last up to 6 weeks. That said, around half the triggers of acute urticaria are as yet unknown. Thankfully, there are universal ways of managing these outbreaks regardless of the catalyst.

The good thing is that, in acute cases, most instances of urticaria don’t actually require any treatment. Simply avoiding the trigger for a few days, or sometimes even only a few hours, can provide enough respite to see the condition subside and normality resume. If it persists beyond this it’s best to seek advice from a consultant. But there are some things you can do in the meantime to help alleviate your symptoms.

Prevention

As often discussed on this blog, non-sedating, over-the-counter antihistamines will work wonders in managing your irritation. As the body reacts, it releases histamine that affects blood vessels and nerves resulting in urticarial flares or swellings. Antihistamines receptors to histamines on blood vessels and nerves. While not curing the root of the problem, will make the symptoms, such as itching, far more bearable.

If the condition persists or is of sufficient intensity, then antihistamines in the standard may not do enough, and in this instance, you need to see a consultant. Documenting the symptoms in SymTrack hive app on daily basis will be very important in making a decision on the required treatment. In accordance with global urticaria guidelines, your consultant will recommend the course of action.

Urticaria isn’t usually enough to stop anyone in their tracks, but it can be a nasty irritant and leave individuals feeling embarrassed in public. The important thing to remember is that you are not alone, and in fact, there are dedicated Urticaria Centres of Reference and Excellence (UCARE) that specialise in this condition and even a World Urticaria Day annually on the 1st October.

If you would like help and advice and to better understand your allergies, please book an appointment at our UCARE centre.

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