Chronic Urticaria: No One Wants to Take It to Work
—A recent study found that more than half of people with chronic urticaria experience a significant impact on their work.
Chronic urticaria (CU) is a common skin condition characterized by the spontaneous development of angioedema. A person with CU may experience chronic spontaneous urticaria (CSU), unpredictable CU attacks, and/or chronic inducible urticaria (CIndU) which can be triggered by various factors. CU often has a significant negative impact on a patient's quality of life, including their ability to work. The duration of CU is also unpredictable and disease control is often suboptimal, especially when treatment is inadequate.
“To assess and compare the occupational impact of CSU and/or CIndU and their treatment, we used objective data combined with patient-reported data in a prospective monocentric study,” Amandine Baudy and colleagues wrote in a recent article published in Acta Dermato-Venereologica. The investigators explored the prevalence of work impairment in CU patients, the factors contributing to it, and the role of treatment in managing its occupational impact.1
.jpg)
About the study design and clinical characteristics of participants
The study, conducted in the dermato-allergology department of Montpellier University Hospital, Montpellier, France, included 88 adult patients with these types of CSU:
- isolated CSU: n=31 (35.2%)
- isolated CIndU: n=19 (21.6%)
- combination of CSU and CIndU: n=38 (43.2%)
Mean age of the patients was 40.9 ± 12 years, and they were diagnosed with CU between July 19, 2021, and July 22, 2022. All met the diagnostic criteria for CU outlined by the French Society of Dermatology. CIndU was confirmed using provocation tests. Most participants enrolled in the study were female (60.2%). Of the total participants, 44 (50%) had experienced angioedema, 80 (90.9%) were receiving medication, and their urticaria control test (UCT) score (7.3 ± 4.6) was indicative of poor disease control.
A survey was developed for both the participant and the physicians to evaluate patient perspective of the impact of CSU versus CIndU on work time. Consequences such as number and duration of work stoppages, job loss, workstation adjustments, or change of profession as well as the Work Productivity and Activity Impairment – Chronic Urticaria (WPAI-CU) score were also assessed as secondary endpoints.
Chronic urticaria does not enhance workplace productivity
The study underscores the burden of CU on occupational activity. Based on survey responses, nearly all patients (96.6%) were working.
- Most patients (n=73, 85.9%) experienced frequent CU symptoms at work, significantly impacting their job performance.
- For 24 of those patients (32.9%), work made CU worse.
- Additionally, 16 patients (18.2%) reported adverse effects of their CU treatment while at work.
- Participants also reported a decline in job satisfaction (n=20; 22.7%) and work performance (n=28; 31.8%).
- Poorly controlled CU was linked to a greater impact on work (odds ratio 1.11 [1.01; 1.24], p=0.034).
While some patients experienced job-related issues like absences, loss of income, or job loss, the specific type of CU did not appear to influence these outcomes.
Impact on patient care
“This study showed that the subjective and objective occupational impact of CU was significant for a majority of patients. Both univariate and multivariate analyses showed that poor disease control, but not the disease type (i.e. the presence of CIndU) or its duration, influenced the occupational impact of the disease,” the authors wrote.
Considering that CU affects 1% of the population at some point in their lives, its impact in the workplace may be substantial. . The authors recommend systematically assessing the occupational impact of CU, especially in cases of suboptimal disease control. Consultation with an occupational health physician may be beneficial in developing a comprehensive management plan. And we need to learn more about the extent to which optimized treatments, including novel therapies for CIndU, can enhance the work-related quality of life and productivity of people with chronic urticaria.
Study limitations and future directions
The study's limitations include its cross-sectional design, which prevents assessing the long-term impact of optimized treatment on work quality of life and productivity. In addition, the focus on a single region with specific economic conditions may limit generalizability of the study results. Lastly, the absence of French-language quality-of-life questionnaires specific to CIndU was also a drawback.
Published:
References
.jpg)
