A survey on the department construction and the treatment concept of chronic urticaria in China

To the Editor, Chronic urticaria is a common inflammation-associated skin disorder, which presents wheals, angioedema or both, lasts >6 weeks [1]. The lifetime prevalence of chronic urticaria is approximately 4.4% globally [1], with a higher incidence of 7.3% reported in China [2]. The pathogenesis of chronic urticaria is complex, and it often recurs [3], which reduces the quality of life of patients and their families [4]. To understand the current status on the dermatology construction and chronic urticaria management, we carried out a 1-month network survey in China based on the Umer APP (Shanghai Maise Information Technology Co., Ltd). Participants are all medical staff. Before the anonymous survey, participants checked the informed consent page and submitted their consent through the survey. The questionnaire was designed based on current urticaria guidelines and expert consensus and was reviewed by senior dermatologists before dissemination. Categorical variables were analyzed using the chi-square test. Statistical analyses were performed using SPSS (version 26.0). A total of 652 (71.0%, 652/918) valid questionnaires were collected (Table 1). There were some differences in the cognition, diagnosis, and treatment of urticaria among medical staff between different hospitals (Supplementary Table S1, Supplemental digital content 1, https://links.lww.com/PA9/A102). The proportion of medical staff in tertiary hospitals (36.3%) who chose ‘omalizumab will be used, but not commonly used’ was significantly higher than that in primary hospitals (15.8%) and secondary hospitals (12.1%) (P < 0.001). Table 1. - Comprehensive data regarding the outpatient status of 652 participants at their respective hospitals Characteristics Mean (±SD) or count (%) Characteristics Mean (±SD) or count (%) Professional titles Proportion of CU patients per outpatient (%) 11.97 ± 9.14 Chief physician 44 (6.7) Age distribution of patients with CU in outpatient settings (%) Associate chief physician 125 (19.2) <12 y 12.73 ± 8.19 Attending physician 254 (39.0) 12–18 y 16.59 ± 10.87 Resident physician 175 (26.8) 18–40 y 34.78 ± 18.65 Others* 54 (8.3) 40–65 y 23.71 ± 11.37 Hospital level >65 y 12.19 ± 7.31 Primary hospital 19 (2.9) Recurrent wheal lesions were diagnosed as (%) Secondary hospital 214 (32.8) CU 55.25 ± 20.22 Tertiary hospital 419 (64.3) Papular urticaria 19.05 ± 14.48 Nature of hospital business Urticarial vasculitis 11.84 ± 6.36 Public hospital 603 (92.5) Autoinflammatory diseases 6.47 ± 4.37 Private hospital 49 (7.5) Others 7.39 ± 9.61 Type of hospital Proportions of different disease types among outpatient patients with CU (%) General hospital 605 (92.8) CSU 48.58 ± 16.58 Dermatology hospital 47 (7.2) CIndU 29.91 ± 14.46 Number of weekly outpatient 6.18 ± 3.76 CSU merge CIndU 21.51 ± 12.84 Number per outpatient Proportions of different disease types among outpatient patients with CIndU (%) <30 316 (48.5) Symptomatic dermographism 31.33 ± 19.79 30–60 325 (49.8) Cholinergic urticaria 16.62 ± 7.10 >60 11 (1.7) Cold urticaria 11.19 ± 4.67 Whether the hospital have a urticaria-specialized outpatient clinic? Delayed pressure urticaria 8.88 ± 5.92 Yes 80 (12.3) Vibratory angioedema 4.98 ± 4.05 No 572 (87.7) Solar urticaria 7.10 ± 6.07 Proportion of CU patients in each outpatient (%) Aquagenic urticaria 4.11 ± 4.04 First visit 49.51 ± 17.83 Heat urticaria 6.59 ± 5.09 Return visit 50.49 ± 17.83 Contact urticaria 9.20 ± 7.88 Whether the department have a designated individual to do patient follow-up? Effectiveness and resistance rates (%) of outpatient antihistamine therapy for CU Yes 211 (32.4) Effective 74.09 ± 14.86 No 441 (67.6) Resistant 25.91 ± 14.86 CIndU, chronic inducible urticaria; CSU, chronic spontaneous urticaria; CU, chronic urticaria.*Others include nurses, medical students, and pharmacists. A total of 32.4% of the medical staff had specially assigned persons in their departments for patient follow-up. 24.8% of the participants had no follow-up for urticaria patients, 16.7% had follow-up for <2 weeks, and only 5.2% had follow-up for >1 year. The underlying barriers to long-term follow-up are primarily attributable to physician workload, a lack of institutional incentives, or patient-related factors, such as self-discontinuation upon symptom relief. Thus, sustainable follow-up requires parallel investments in patient education and systematic monitoring that reinforce disease management even during remission. The most commonly used tool for patient follow-up was WeChat APP (Tencent Technology, Shenzhen Co., Ltd., Shenzhen, Guangdong, China). In terms of follow-up content, the most emphasized items in patient diaries were itching degree and wheal number/area (94.5%). Regarding patient education, face-to-face education was the most frequently adopted method by medical staff (98.2%) (Supplementary Figure S1, Supplemental digital content 2, https://links.lww.com/PA9/A103). However, significant disparities in follow-up tool adoption were observed across hospital tiers. Primary hospitals predominantly used informal tools, such as WeChat, while tertiary hospitals favored standardized systems like electronic medical records (Supplementary Table S2, Supplemental digital content 1, https://links.lww.com/PA9/A102). This highlights the lack of structured follow-up infrastructure and standardized protocols in primary hospitals. The widespread adoption of WeChat for patient follow-up in China underscores the potential of mobile health platforms in managing chronic diseases, providing a replicable model for other Asia-Pacific regions experiencing similar trends in digital health integration. In addition to medical history, family history, and physical examination, the most common test for chronic urticaria is differential blood count (including complete blood count with five-part differential: neutrophils, lymphocytes, eosinophils, basophils, and monocytes) (90.5%), followed by serum total immunoglobulin E level (89.1%). Notably, across all hospital tiers, tertiary hospitals exhibited the highest utilization rate of total immunoglobulin E/allergen screening among diagnostic modalities (P = 0.018), providing a stronger evidence base for the recommendation to ‘strengthen primary care training’ (Supplementary Table S2, Supplemental digital content 1, https://links.lww.com/PA9/A102). The treatment for chronic urticaria was primarily based on second-generation H1 antihistamines (96.9%). Regarding chronic urticaria management, adequate communication with patients was deemed most critical (94.2%). For antihistamine-resistant cases, combining second-generation H1 antihistamines with first-generation antihistamines was the preferred strategy (74.8%) (Supplementary Table S3, Supplemental digital content 1, https://links.lww.com/PA9/A102). Most respondents reported short treatment cycles, with the highest proportion indicating <2 months (37.0%). Omalizumab significantly reduced clinical signs and symptoms in patients with chronic urticaria [5]. 22.1% of participants chose omalizumab during chronic urticaria treatment. The primary factor favoring its use was antihistamine resistance (85.9%), while the decision not to use it was most often attributed to economic reasons, and the second reason is no certainty about the safety of new drugs. Omalizumab was included in China’s National Reimbursement Drug List in 2023 and retained in the 2026 update. Although the National Reimbursement Drug List listing aims to reduce patient costs, reimbursement policies and rates under the Dual-Channel Medical Insurance system differ significantly across regions. In addition, omalizumab’s medical insurance payment standard remains high and typically requires long-term treatment. Consequently, out-of-pocket expenses continue to impose substantial financial pressure on specific patient groups, sustaining economic barriers to access. Medical staff perceived that omalizumab might not lead to significant improvement primarily because of the heterogeneity of chronic urticaria subtypes (91.6%). Regarding treatment duration, the most common treatment cycle reported was <3 months (36.0%). Overall, more than half of the participants (53.4%) reported that patients were satisfied with omalizumab treatment (Supplementary Figure S2, Supplemental digital content 2, https://links.lww.com/PA9/A103). In China, adherence to urticaria guidelines is common, yet disparities remain across hospital levels. Training should be enhanced, particularly in primary and secondary care, and patient education must be improved to address low long-term follow-up rates. The increasing establishment of specialized urticaria clinics is encouraging and supports more standardized diagnosis and treatment, ultimately improving chronic urticaria management. Acknowledgements This work was supported by the National Natural Science Foundation of China (Grant Nos. 82473532, 82173424) and the Key Project of Hunan Provincial Natural Science Foundation (Grant No. 2025JJ30040). Conflicts of interest The authors have no financial conflicts of interest. Author contributions Jie Li initiated and designed the study and acquired the funding. Wang Jiayi, Guo Xin, and Peng Cong analyzed the data and wrote the manuscript. Xiong Feng and Cao Qiaozhi were responsible for data collection. All authors contributed to editing the manuscript and approved the final manuscript. Ethics statement The survey was both confidential and anonymous, participants were provided a statement before the survey that informed them of the survey’s purpose and that it was voluntary; consent was implied by submitting the survey. Consent for publication All authors have read and approved the final version of the manuscript and consent to its submission for publication. Data availability statement The datasets analyzed in this study are not publicly available because of privacy restrictions but are available from the corresponding author upon reasonable request.