Impact of Chronic Urticaria on Major Life-Changing Decisions: Greater Burden in Social, Physical, and Job/Career Domains

Abstract

Background: Chronic urticaria (CU) is a common condition associated with a substantial burden on patients and society, characterized by persistent symptoms and reduced sense of life control. Although existing patient-reported outcome measures (PROMs) assess disease activity and quality of life, they largely reflect the current disease state, and evidence on CU's long-term impact on major life-changing decisions (MLCDs) remains scarce. Objectives: To evaluate CU's long-term impact on MLCDs and assess the validity and reliability of the Turkish MLCDP. Methods: The MLCDP is a 32-item questionnaire assessing the impact of chronic diseases on MLCDs across five domains. A linguistically validated Turkish version was developed using a forward-backward translation process. In this multicentre cross-sectional study, 111 Turkish-speaking CU patients (>= 16 years) completed the MLCDP and other PROMs during follow-up visits. Results: CU affected at least one MLCD in 79.3%, impacting social (77, 69.4%), physical (63, 56.8%), job/career (41, 36.9%), family/relationships (23, 20.7%) and education (9, 8.1%) domains. The most commonly affected decisions of each domain were changing eating habits (67, 60.4%), not taking part in any sport activities (35, 31.5%), working flexible hours (26, 23.4%), not having a sexual relationship (16, 14.4%) and studying near home (6, 5.4%), respectively. Patients with disease onset <= 45 years had higher rates of at least one affected MLCD than those > 45 years (74, 82.2% vs. 10, 58.8%, p < 0.05). Similarly, patients with an emergency referral in the last year (30, 93.8% vs. 58, 74.4%) and those who missed school/workdays in the last year (24, 100% vs. 64, 73.6%) showed higher rates of at least one affected MLCD compared with those without (all p < 0.05). Limitations: The small sample size, single-cohort cross-sectional design, lack of controls, self-reported measures, inclusion of patients with short disease duration and unassessed potential confounders such as comorbidities, medications and personality traits. Conclusions: CU has a long-term impact on major life-changing decisions, especially in social, physical, and job/career decisions of the patients. Younger patients and those with severe disease are particularly affected.