Older Age, High BMI, Early Steroids Linked With Longer Urticaria Duration

While most patients with urticaria in the primary care setting recover quickly, a notable proportion develop chronic urticaria (CU), according to new research published in Clinical & Experimental Allergy.¹

The study identified higher age at onset, high body mass index (BMI), and early prednisolone prescriptions as key determinants of long disease duration. These findings have significant implications for CU management.

“Determining the exact proportion of CU patients is essential, because a substantial part of this population requires long-term additional treatment in the second and third line due to high severity,” the authors wrote. “Identifying early indicators of CU could further improve treatment optimization, timely referral, and adequate expectation management.”

Investigating Urticaria Disease Duration in Primary Care

The study was based on retrospective cohort data from the Julius General Practitioner Network (JGPN) database in the Netherlands, encompassing approximately 450,000 patients. The cohort included 16,892 patients with new-onset urticaria between 2010 and 2019, all of whom first presented to a general practitioner (GP). The researchers aimed to establish current disease duration patterns and identify early indicators of chronic disease, defined in the study as having GP consultations for urticaria more than 6 weeks apart.

The analysis found that 75% of patients had urticaria lasting less than 1 week, and 83% fulfilled the criteria for acute urticaria (AU), defined as a duration of 6 weeks or less. However, 17% (n = 2836) of the cohort transitioned to CU, with a median duration of 1 year and a median of 4 GP consultations related to urticaria.

“Only one population-based study using insurance data investigated the proportion developing CU among both children and adults with new-onset urticaria (n = 49,129),² reporting a far lower rate of 6%,” the authors noted. Patient selection was significantly different in that study, however, because inclusion criteria included at least 2 visits and a prescription, which likely excluded patients with AU or mild CU who did not need medication or who used over-the-counter medication, the authors added.

Identifying Determinants of Chronic Urticaria

To identify early indicators, the researchers performed multivariable logistic regression analyses focusing on characteristics present at baseline or prior to the initial GP visit. The primary analysis associated 3 main factors with chronic urticaria:

• Higher age at urticaria onset (log-transformed odds ratio [OR], 1.15; 95% CI, 1.10-1.19), which aligns with prior studies that found younger age linked to faster remission
• BMI ≥ 25 (OR, 1.37; 95% CI, 1.20-1.56), which may be due to the ongoing inflammatory process induced by adipokines
• Prednisolone use within the first week (OR, 1.39; 95% CI, 1.06-1.83), with the authors noting that early steroid prescription is likely a proxy for higher disease severity at presentation

Unlike some prior studies, the current research found no association between infection around the time of onset and CU.

The study suggests that in patients whose symptoms persist beyond 1 week and who also present with one or more of the early determinants identified in the study population GPs should consider timely treatment escalation, early referral to a specialist, and adequate expectation management.

“This large primary care–based study provides valuable insights into the course of urticaria in an unselected population, demonstrating that most patients recover quickly within 1 week, while a notable 17% develop chronic urticaria,” the authors concluded. “Higher age at onset, high BMI, and prednisolone use in the first week were found to be determinants of long disease duration.”

References

1. Soegiharto R, Hengevelt BJ, Boekema-Bakker N, et al. Exploring the disease duration of urticaria and associated determinants in primary care. Clin Exp Allergy. Published online October 30, 2025. doi:10.1111/cea.70170

2. Eun SJ, Lee JY, Kim DY, Yoon HS. Natural course of new-onset urticaria: Results of a 10-year follow-up, nationwide, population-based study. Allergol Int. 2019;68(1):52-58. doi:10.1016/j.alit.2018.05.011