Chronic Spontaneous Urticaria Prevalence in US Greater Than Previously Reported

A real-world study revealed a greater prevalence of chronic spontaneous urticaria (CSU) in the United States than previously reported, with an estimated weighted prevalence of 0.78%.1

Studies have previously reported a point prevalence of chronic urticaria in the United States from 0.10% to 0.23%. When it comes to the point prevalence of CSU, studies have yielded inconsistent findings.

A US study using insurance claim databases reported a yearly prevalence of diagnosed CSU at 0.08% to 0.11%.2 A cross-sectional study using electronic health records reported a point prevalence of 0.23%.3 Another study using NHWS data reported a 0.4% prevalence of CSU; this study had based a CSU diagnosis on diagnosed chronic hives as a proxy.4

“…epidemiological estimates of CSU specifically are limited in the United States, and these estimates tend to vary depending on the underlying data source,” wrote investigators, led by Weily Soong, MD, from AllerVie Health-Alabama Allergy & Asthma Center, Clinical Research Center of Alabama.1 “Given the paucity of published evidence, there is a need to accurately assess the prevalence and burden of CSU on the affected individuals in the US healthcare system.”

In this cross-sectional study, investigators sought to estimate the burden, clinical profile, and prevalence of CSU in the US using data from the 2019 National Health and Wellness Survey. Specific measures included the 36-item Short Form Survey version 2 (SF-36v2), Short-Form 6 Dimension (SF-6D) and EuroQol-5 Dimension (EQ-5D) utility scores, Dermatology Life Quality Index (DLQI), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), and Work Productivity and Activity Impairment (WPAI) questionnaire. They also examined healthcare resource utilization over the past 6 months.

Among 74,994 respondents, 815 had physician-diagnosed chronic urticaria, and 635 (77.9%) had CSU. The analysis included adults who self-reported receiving a CSU diagnosis from a healthcare provider in the past 12 months.

The weighted prevalence of diagnosed CSU was 0.78%. About half of the participants with diagnosed CSU were female (51.7%), and the mean age at diagnosis was 37 years. Participants had a mean disease duration of 11 years.

The physical and mental component summary scores on the SF-36v2 were lower than the scores observed for the overall NHWS population. The mean SF-6D and EQ-5D health utility scores were 0.54 and 0.62, respectively. Participants had a mean DLQI score of 13.8, and more than 74% reported anxiety (GAD-7 ≥ 5) and depression (PHQ-9 ≥ 5).

On average, 36.5% of CSU respondents experienced absenteeism, 67.2% had reduced productivity while at work (presenteeism), 73.1% had overall work impairment, and 62.6% had activity impairment. Participants with CSU had significantly worse impairment in these areas compared to the general NHWS population.

Most patients (96.5%) visited any healthcare provider, and more than half had an emergency department visit (60.2%) or required hospitalization (55.9%). In fact, patients with CSU had 4 times more emergency department visits and 6 times more hospitalizations compared to the general NHWS population.

In total, 77% of patients in the sample had a poorly controlled disease. Most may have visited a healthcare provider, but only 16.4% received their CSU diagnosis from a dermatologist. Additionally, only 19.2% reported having a dermatology visit in the past 6 months.

“The research reveals that most individuals with CSU suffer from inadequate disease management and insufficient treatment,” investigators concluded. “This leads to negative impacts on their mental and physical well-being, as well as hindrances in their work and everyday life…This study draws attention to the importance of improving management of this condition and highlights the unmet needs of this population.”

References

1. Soong W, Patil D, Rodrigues J, et al. Clinical profile, prevalence, and burden of chronic spontaneous urticaria in the United States, World Allergy Organization Journal, Volume 18, Issue 8, 2025, https://doi.org/10.1016/j.waojou.2025.101081.

2. Zazzali JL, Broder MS, Chang E, Chiu MW, Hogan DJ. Cost, utilization, and patterns of medication use associated with chronic idiopathic urticaria. Ann Allergy Asthma Immunol. 2012;108(2):98-102. doi:10.1016/j.anai.2011.10.018

3. Wertenteil S, Strunk A, Garg A. Prevalence estimates for chronic urticaria in the United States: A sex- and age-adjusted population analysis. J Am Acad Dermatol. 2019;81(1):152-156. doi:10.1016/j.jaad.2019.02.064

4. Vietri J, Turner SJ, Tian H, Isherwood G, Balp MM, Gabriel S. Effect of chronic urticaria on US patients: analysis of the National Health and Wellness Survey. Ann Allergy Asthma Immunol. 2015;115(4):306-311. doi:10.1016/j.anai.2015.06.030