PS62 Chronic spontaneous urticaria: delays in access to successful treatment are long and highlight clinical and psychosocial burden

Abstract

Chronic spontaneous urticaria (CSU) is a relapsing inflammatory skin condition with significant physical and psychosocial burden. Despite clear NICE guidance on escalation and referral, delays in accessing specialist care persist. This study was designed to (i) assess time to specialist review, (ii) evaluate clinical and psychosocial severity at presentation and (iii) explore potential correlations between these parameters. Consecutive patients attending a tertiary urticaria clinic between March 2024 and September 2025 were reviewed. Inclusion required a confirmed diagnosis of CSU. Patients referred from emergency care, with concurrent dermatological diagnoses, or prior CSU care in private-sector or overseas settings were excluded. Clinical severity was assessed using Urticaria Activity Score (UAS7). Psychosocial severity was graded using the Clinical Global Impression scale, informed by Dermatology Life Quality Index (DLQI) scores and documented psychological morbidity. Associations between clinical and psychosocial severity and time to specialist review were analysed using Spearman’s correlation and logistic regression. Sixty-two patients were included (27% male; mean age 42 years). The mean time from symptom onset to specialist review was 46 months (median 24). Clinical severity was severe in 32%, moderate in 23%, mild in 15% and unspecified in 31%. Psychosocial burden was severe in 27%, moderate in 10%, mild in 5% and unspecified in 58% Clinical and psychosocial severity were positively correlated (ρ = 0.56, P = 0.008). Time to specialist review showed no association with psychosocial severity and an inverse trend with clinical severity (odds ratio per month 0.99, P = 0.04). All patients commenced on omalizumab showed clinical and psychosocial improvement, with mean UAS7 and DLQI reductions of 30.4 and 20.3, respectively, at 4 months. Patients with CSU experience prolonged delays before specialist assessment and present with advanced clinical and psychosocial disease. Although time to specialist review did not correlate with psychosocial severity, prolonged delays worsen cumulative disease burden. Early optimization in primary care, adherence to NICE pathways, and integrated psychosocial assessment may reduce disease burden and improve outcomes.