Chronic spontaneous urticaria (CSU) can have a profound impact on a patient’s quality of life (QOL), with consequences that extend well beyond itch and hives to include sleep disturbance, emotional burden, and disruption of daily functioning. Studies presented at the 2026 AAAAI Annual Meeting underscored the substantial patient burden associated with CSU, particularly in relation to disease control, health care resource utilization, and patient-reported outcomes (PROs).

Following these presentations, featured expert David M. Lang, MD, was interviewed by Conference Reporter Editor-in-Chief Tom Iarocci, MD. Clinical perspectives from Dr Lang on these findings are presented here.

Recent evidence has confirmed that CSU has a huge impact on QOL. Sleep disturbance is an underestimated burden in patients with CSU. These patients have problems falling asleep and staying asleep, and they are often dissatisfied with their sleep pattern. This impact on sleep can interfere with daily functioning, and, not surprisingly, the data show that patients with higher pruritus scores are less satisfied with their sleep pattern.

The QOL impairment in patients with CSU can be at a similar level as that observed in patients with coronary artery disease awaiting coronary artery bypass surgery. Additionally, a 2023 study from South Korea reported that the QOL impairment for patients with poorly controlled chronic urticaria was comparable to that for patients with rheumatoid arthritis and insulin-dependent diabetes. Another study found that patients whose physicians discussed the emotional impact of chronic urticaria with them were significantly more satisfied with their treatment and were more trusting of their physicians. CSU also strongly impacts health-related QOL, especially when it is associated with uncontrolled disease.

This leads to a discussion of PRO measures (PROMs). Guidelines have encouraged providers to use validated tools when caring for their patients at initial and subsequent visits. There are a number of validated QOL instruments for CSU, including the Urticaria Activity Score over 7 days (UAS7), the Angioedema Activity Score over 7 days (AAS7), and the Urticaria Control Test (UCT), which has a recall period of 4 weeks. So, it is important to use PROM tools as a routine component of caring for patients with CSU. When used routinely, these PROMs can help classify patients with CSU as being not well controlled, well controlled, and hive free.

At the recent 2026 AAAAI Annual Meeting, Marc Riedl, MD, MS, presented a study analyzing health care resource utilization among patients with CSU in the United States by level of disease control (abstract 21). Dr Riedl and colleagues found that patients with poorly controlled CSU have increased health care resource utilization. So, from a public health standpoint, this study implies that the approach to the management of CSU should entail identifying the patients with CSU who are not well controlled and then intervening so that they can achieve disease control. In doing so, we have not only improved the QOL of these patients but also accomplished a substantial reduction in health care costs.

In another study from AAAAI 2026, Giselle Mosnaim, MD, MS, FAAAAI, presented a descriptive analysis of racial differences in demographic and baseline disease characteristics of patients with CSU, pooling data from several clinical trials (abstract 33). Of note, Black patients had a longer disease duration and a greater impairment of their QOL due to their CSU compared with Asian and White patients. Additional epidemiologic studies using large databases will be required to achieve a clearer understanding of these differences.