Correlation of disease activity (Urticaria Activity Score over 7 Days) and quality of life (Chronic Urticaria Quality of Life Questionnaire) in patients with chronic spontaneous urticaria: A prospective observational study

Background: Chronic spontaneous urticaria (CSU) significantly impairs patient quality of life (QoL) through recurrent wheals and pruritus. The urticaria activity score over 7 days (UAS7) and the chronic urticaria quality of life questionnaire (CU-Q2oL) are validated patient-reported outcome measures recommended by international guidelines for monitoring CSU. Whether these two measures track in parallel over a structured treatment course, particularly as disease activity diminishes, remains incompletely characterized, especially in South Asian populations. Methods: A 6-month prospective observational study was conducted at a tertiary-care dermatology center in India. Fifty adult patients with active CSU were enrolled. All received second-generation H1-antihistamines (cetirizine, levocetirizine, or fexofenadine) with dose up-titration up to fourfold as needed per international urticaria guideline recommendations guideline recommendations. No patients required omalizumab during the study period. The UAS7 and CU-Q2oL scores were recorded at baseline and monthly for 6 months. Baseline total serum immunoglobulin E (IgE) values and absolute eosinophil counts (AEC) were correlated with the clinical scores. Statistical analysis included Wilcoxon signed rank tests for longitudinal change and the Spearman rank correlation at each time point. The sample size was based on clinical feasibility; the study is considered exploratory. Results: The mean ± standard deviation baseline UAS7 score was 30.3 ± 9.1 (severe disease), and the mean ± standard deviation CU-Q2oL score was 51.4 ± 13.2. Both scores improved significantly by 6 months (UAS7 score: 5.1; CU-Q2oL score: 12.5; p < 0.0001 for both). The UAS7‐CU-Q2oL correlation was moderate when the disease was active (Spearman r = 0.44, p = 0.002 at 1 month) but weakened substantially as disease activity declined (r ≈ 0.25, p = 0.08 at 3 months; r ≈ 0.08, p > 0.5 at 6 months). Baseline total IgE value and AEC did not correlate with disease severity or QoL at any time point. Conclusion: UAS7 and CU-Q2oL scores correlate during active CSU but diverge as disease is controlled. Even after symptom resolution, some patients retain residual QoL impairment. Routine use of both measures is recommended because UAS7 alone may underestimate the patient burden during remission. The total IgE value and AEC are not reliable surrogate markers of CSU severity or QoL in this exploratory cohort.