TOPLINE:

Women with chronic spontaneous urticaria (CSU) experienced more severe symptoms, including higher rates of angioedema, systemic symptoms, and comorbidities, with poorer treatment responses than men. The disease burden peaked during midlife among women, marked by worse quality of life.

METHODOLOGY:

• Researchers analysed baseline data from an international real-world registry (Chronic Urticaria Registry [CURE]) and included 4136 patients (72.4% women) with CSU from 58 sites across 29 countries.
• Data included demographics, disease characteristics, patient-reported outcome measures (Urticaria Activity Score over 7 days, Urticaria Control Test [UCT], and Chronic Urticaria Quality of Life Questionnaire [CU-Q2oL]), systemic symptoms, comorbidities, laboratory parameters, treatment distribution, and response rates (poor disease control defined as UCT scores < 12).
• Participants' age was stratified into the following groups: < 13, 13-17, 18-30, 31-50, 51-65, and > 65 years.
• Sex-based differences were evaluated and analysed on the basis of the data collected.

TAKEAWAY:

• Most of the patients with CSU were women, with significant dominance from the age of 31 years (P < .001); the most significant difference in disease burden was seen among women during midlife (age, 51-65 years; P < .05) compared with that among age-matched men.
• Overall, women showed higher rates of angioedema (65.0% vs 59.2%; P < .001), a family history of CSU (8.6% vs 5.2%; P = .002), and systemic symptoms (P < .001) than men.
• Women showed a higher frequency of most comorbidities, including asthma, thyroid disease, obesity, autoimmune disease, gastrointestinal disease, and depression (P < .05 for all), and men had a higher rate of diabetes (P = .004) and smoking and alcohol consumption (P < .001).
• The quality of life was poorer in women than in men (mean CU-Q2oL score, 32.1 vs 27.7; P < .001); sleep disturbance was higher in women than in men (38.9% vs 32.5%; P < .001); a higher proportion of women with CSU had poor disease control than men globally (72.8% vs 68.3%; P = .010) and in each treatment category.
• Women aged 31-50 years had higher rates of angioedema, systemic symptoms, comorbidities, and sleep disturbance; however, after the age of 65 years, only the rate of angioedema and comorbidities was significantly higher in women than in men (P < .05 for all).

IN PRACTICE:

"Female patients with CSU suffer far greater burdens from the disease than males, with more systemic symptoms, comorbidities, worse QoL [quality of life], poorer disease control and responses to treatments. Our findings challenge the traditional notion that females overreport symptoms," the authors wrote. "Instead, we demonstrate a biological basis for these findings, supported by PROMs [patient-reported outcome measures], laboratory findings and a higher prevalence of comorbid diseases," they added.

SOURCE:

This study was led by Emek Kocatürk, Institute of Allergology, Charité — Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt — Universität zu Berlin, Berlin, Germany. It was published online on September 18, 2025, in the Journal of the European Academy of Dermatology and Venereology.

LIMITATIONS:

This study had small sample sizes in younger patient groups and incomplete UCT data for some participants. The absence of biomarker evaluation limited the ability to determine whether CSU in women adopts more type IIb autoimmune patterns with age. The lack of hormonal profile data restricted the analysis of hormonal transitions' role in CSU progression. Additionally, other potential stressors, such as caregiving roles and the work-life impact, were not assessed.

DISCLOSURES:

CURE received funding from Novartis, Noucor, Sanofi, and Moxie. However, this specific study did not receive any dedicated funding. Several authors reported acting as speakers/advisors and having other ties with various pharmaceutical companies. Full disclosures are mentioned in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.