Highlight
1. Patients with chronic urticaria (CU) highly value rapid and sustained relief from hives, itching, and swelling, preferably within 2 days to 2 weeks.
2. There is a preference for treatments that are easy to prepare and self-administer, with oral or topical therapies favored over injections or infusions.
3. Safety and tolerability concerns increasingly influence patient willingness to accept treatment burdens, especially as adverse effect risks rise.
4. Incorporating patient and caregiver preferences into clinical guidelines may enhance the relevance and trustworthiness of chronic urticaria management strategies.
Study Background
Chronic urticaria is a distressing condition characterized by recurrent hives, itching, and sometimes angioedema lasting longer than six weeks. It significantly impairs quality of life due to persistent discomfort, sleep disturbance, and cosmetic concerns. While multiple effective therapies exist, treatment response can vary, and adverse effects pose management challenges. Recent clinical advances stress the importance of integrating patient values and preferences in therapeutic decisions to enhance satisfaction and adherence. The American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma and Immunology have recognized the need to update their chronic urticaria guidelines to address these patient-centered aspects. Prior to this systematic review, a comprehensive synthesis of patient and caregiver perspectives on CU treatment was lacking.
Study Design
This systematic review searched MEDLINE, Embase, PsycINFO, and CINAHL databases from inception to May 15, 2025, to identify studies exploring values and preferences of patients with chronic urticaria and their caregivers regarding treatment options. A total of 18 studies involving 28,497 participants were included. Two independent reviewers screened articles, extracted data, and assessed risk of bias. Qualitative synthesis employed thematic and inductive content analysis, and confidence in evidence was graded using the GRADE-CERQual approach, which evaluates credibility and data adequacy in qualitative research.
Key Findings
The systematic review found that patients prioritize rapid symptom improvement, with preferred timeframes ranging from 2 days to 2 weeks for noticeable relief of hives, itch, and swelling. This rapid effectiveness was a key driver of treatment acceptance and satisfaction.
Long-term effectiveness and the durability of symptom control were also highly valued, with patients favoring treatment regimens that could maintain symptom-free intervals over extended periods, improving quality of life and reducing disease burden.
Regarding mode of administration, oral and topical therapies were preferred for ease of preparation, use, and self-management, reflecting patient desires for convenience and autonomy. In contrast, treatment via injections was less favored, and infusions were the least desirable, likely due to increased invasiveness and complexity.
The review also highlighted safety and tolerability as major considerations. When treatments were associated with minor feasibility burdens (e.g., frequency of doses), patients were generally willing to accept these if symptom relief was rapid and sustained. However, as the risk or severity of adverse effects increased – such as kidney injury or vomiting – patients shifted priorities, placing greater emphasis on avoiding harms over rapid symptom resolution.
The evidence for these preferences was rated as moderate certainty for rapid symptom improvement, treatment convenience, and long-term effectiveness, and low certainty for acceptance of burdens balanced against safety concerns.
Expert Commentary
These findings align with general principles emphasizing shared decision-making and the incorporation of patient-reported outcomes in chronic disease management. The prioritization of rapid and durable symptom control underscores the urgent daily impact of CU symptoms on patients’ lives. Preferences for less invasive administration routes may inform prescribing practices and the development of novel therapies that meet these needs.
Limitations of the review include heterogeneity among study designs and populations, potential cultural and geographic variations in preferences, and limited data on pediatric populations and caregivers specifically. Additionally, qualitative synthesis inherently involves interpretative judgments, so individual patient preferences might vary widely. Nonetheless, this review provides an important evidence base for guideline committees, clinicians, and researchers aiming to optimize patient-centered care in CU.
Conclusion
This systematic review underscores that patients with chronic urticaria value treatments offering rapid, sustained control of hives, itching, and swelling, favoring convenient oral or topical therapies. As risks of adverse effects increase, patients’ priorities transition from efficacy towards safety and tolerability, highlighting the critical balance clinicians must achieve when recommending therapies. Incorporating these patient and caregiver insights can enhance the trustworthiness and relevance of clinical guidelines, support individualized treatment strategies, and stimulate development of novel interventions aligned with patient preferences. Further research is warranted to explore preferences across diverse populations and integrate quantitative measures of patient values into treatment algorithms.
References
Chu X, Mubasher J, Chen L, et al. Patient Values and Preferences in Chronic Urticaria Treatment: A Systematic Review. JAMA Dermatol. 2025 Oct 8. doi:10.1001/jamadermatol.2025.3663. Epub ahead of print. PMID: 41060663.
