Introduction:
Chronic urticaria (CU) is a skin disorder in which red, swollen, itchy,
and sometimes painful hives (wheals), angioedema, or both, repeatedly
occur for more than 6 weeks.1 Prevalence is estimated
up to 1% in the general population2, with those aged
between 30 and 50 years most affected, and females affected
approximately twice as often as males.3-6 The current
guidelines classify CU as spontaneous (chronic spontaneous urticaria
[CSU], with no specified eliciting factor involved) or inducible
(chronic inducible urticaria [CIndU], with a specific eliciting
factor involved).1 Patients may concurrently experience CSU and CIndU in
approximately 20% of cases.4
Existing evidence indicates that symptoms of CU have a deleterious
effect on the quality of life (QoL).2,7-9 It impacts
daily activities and emotional well-being; some patients‘ health status
is comparable to that of coronary artery disease and severe asthma
patients. It also causes inconvenience in family structures,
compromising performance at work, school, and negatively impacting on
leisure activities. It compromises patients’ QoL, mainly those with more
severe disease or who are diagnosed with chronic spontaneous
urticaria.7,10 Until now there are no reliable
biomarkers to identify and measure disease activity in CSU.
Consequently, use of patient reported outcomes (PROs) is crucial when
evaluating and monitoring different aspects of chronic urticaria such as
disease activity/severity, disease control, and QoL. Five different PROs
that measure various aspects of disease severity/activity and QoL are
used routinely in research and clinical practice of chronic urticaria.
Four of these PROs are urticaria-specific: weekly Urticaria Activity
Score (UAS7); Urticaria Control Test (UCT); and Chronic Urticaria
Quality of Life Questionnaire (CU-Q2oL); two are angioedema-specific:
Angioedema Activity Score (AAS) and Angioedema Quality of Life
Questionnaire (AE-QoL).11-15
Numerous other factors also may influence QoL. Among those likely to be
important is spiritual well-being (SpWB). Viewed as a multifaceted
construct, SpWB usually refers to a sense of meaning or purpose in life,
inner peace and harmony, and the strength and comfort drawn from
faith.16 SpWB has been measured over two dimensions
(Meaning/Peace and Faith). Recent studies suggest a broad protective
relationship between religious participation and population
health.17 Although a positive effect of addressing
spirituality in health care has been proved in several chronic diseases,
spiritual well-being in patients with CU has never received attention.
The aim of this study was to evaluate spirituality and QoL in CU
subjects with different control levels (subjects with controlled CU and
those with not controlled CU).