Diagnostic Delay in Patients With Chronic Urticaria: Results From the Chronic Urticaria Registry (CURE)

Muñoz M. Salameh P. Zajac M. Fomina D. Kovalkova E. Bobrikova E. Andrenova G. Kasperksa-Zajac A. Aulenbacher F. Herzog L.S. Grekowitz E.M. Buttgereit T. Giménez-Arnau A.M. Planella-Fontanillas N. Pesque D. Puertolas M. Kulthanan K. Tuchinda P. Bizjak M. Košnik M. Khoshkhui M. Azad F.J. Meshkova R. Savchenko S. Makris M. Papapostolou N. Peter J.G. Day C. McDougall C. Abuzakouk M. Bouillet L. Bauer A. Parisi C.A.S. Gregoriou S. Staubach-Renz P. Dissemond J. Kocatürk E. van Doorn M.B.A. Asero R. Grattan C. Thomsen S.F. Du-Thanh A. Hackler Y. Weller K. Kolkhir P.
2026 John Wiley and Sons Inc

Clinical and Experimental Allergy
2026

Background: Chronic urticaria (CU) diagnosis includes the patients clinical history and physical examination. However, atypical presentations or misdiagnosis can lead to diagnostic delay (DD). Objective: The impact and contributing factors of DD in CU are unknown and were assessed in the present study. Methods: We retrospectively analysed data from CU adult patients from the international, multicenter Chronic Urticaria Registry (CURE). Results: Of 4332 CU patients, 61% had standalone chronic spontaneous urticaria (sCSU), 18% had ≥ 1 form of chronic inducible urticaria (CIndU), and 21% had a combination of both (CSU + CIndU). Diagnosis of CU was delayed in 24% of patients by at least 1 year. CIndU patients showed a longer DD compared to those with sCSU or CSU + CIndU (median, [IQR]: 4, [0–22] vs. 1, [0–6] vs. 2, [0–9] months, p < 0.001). Among CIndU patients, symptomatic dermographism (n = 264) and cholinergic urticaria (n = 103) patients had the longest DD compared to all other CIndU subgroups (median: 4 months, p = 0.005 for both). In CIndU patients, a longer DD was associated with having an additional CIndU (OR: 12.8, p = 0.03), younger age, comorbidities, lower disease control, and lack of second-generation H₁-antihistamine treatment. In CSU patients, a DD of ≥ 6 months was associated with lower CSU activity (median weekly Urticaria Activity Score of 14 vs. 21, p = 0.02) compared to that of DD < 6 months. Conclusions: Diagnosis of CU is delayed in one out of four patients. Greater awareness of the guideline-recommended CU classification, clinical presentation, and diagnostic work-up can facilitate CU diagnosis.

burden , chronic inducible urticaria , chronic spontaneous urticaria , chronic urticaria , CURE , diagnosis , diagnostic delay , registry

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Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
School of Medicine, Lebanese American University, Byblos, Lebanon
Institut National de Santé Publique dÉpidémiologie Clinique et de Toxicologie-Liban (INSPECT-LB), Beirut, Lebanon
Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
European Center for Diagnosis and Treatment of Urticaria, Medical University of Silesia, Katowice, Poland
Moscow Research and Clinical Center of Allergy and Immunology, City Clinical Hospital 52, Moscow Healthcare Department, Moscow, Russian Federation
Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
Department of Pulmonology, Astana Medical University, Astana, Kazakhstan
Department of Dermatology, Hospital del Mar Research Institute, Universitat Pompeu Fabra, Barcelona, Spain
Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk, Russian Federation
Allergy Unit “D. Kalogeromitros”, 2nd Department, Dermatology and Venereology, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
Allergy and Immunology Unit, UCT Lung Institute, Cape Town, South Africa
Division of Allergy and Clinical Immunology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
Allergy & Immunology Department, Cleveland Clinic AbuDhabi, Abu Dhabi, United Arab Emirates
French National Reference Center, CREAK, Department of Internal Medicine and Clinical Immunology, CHU Grenobles Alpes, Grenoble, France
Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
Adults and Pediatric Allergy Sections, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
National and Kapodistrian University of Athens, 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Athens, Greece
Department of Dermatology, University Medical Center Mainz, Mainz, Germany
Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany
Bahçeşehir University School of Medicine, Department of Dermatology, Istanbul, Turkey
Department of Dermatology, Erasmus MC, Rotterdam, Netherlands
Centre for Human Drug Research, Leiden, Netherlands
Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Milan, Italy
Guys Hospital, St Johns Institute of Dermatology, London, United Kingdom
Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
University and University Hospital of Montpellier, Montpellier, France
UNEV gGmbH, Berlin, Germany

Institute of Allergology
Fraunhofer Institute for Translational Medicine and Pharmacology ITMP
School of Medicine
Institut National de Santé Publique dÉpidémiologie Clinique et de Toxicologie-Liban (INSPECT-LB)
Department of Primary Care and Population Health
Faculty of Pharmacy
European Center for Diagnosis and Treatment of Urticaria
Moscow Research and Clinical Center of Allergy and Immunology
Department of Clinical Immunology and Allergology
Department of Pulmonology
Department of Dermatology
Department of Dermatology
Division of Allergy
Faculty of Medicine
Allergy Research Center
Department of Clinical Immunology and Allergology
Allergy Unit “D. Kalogeromitros”
Allergy and Immunology Unit
Division of Allergy and Clinical Immunology
Allergy & Immunology Department
French National Reference Center
Department of Dermatology
Adults and Pediatric Allergy Sections
National and Kapodistrian University of Athens
Department of Dermatology
Department of Dermatology
Bahçeşehir University School of Medicine
Department of Dermatology
Centre for Human Drug Research
Ambulatorio di Allergologia
Guys Hospital
Department of Dermatology
Department of Biomedical Sciences
University and University Hospital of Montpellier
UNEV gGmbH

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