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A Retrospective Analysis of Clinical Characteristics and Socioeconomic Factors Influencing Treatment Choices in Chronic Spontaneous Urticaria
Abstract   Peer reviewed

A Retrospective Analysis of Clinical Characteristics and Socioeconomic Factors Influencing Treatment Choices in Chronic Spontaneous Urticaria

Charu Debnath, Loza Kebret, Samuel Chin and Zhen Ren
Journal of allergy and clinical immunology, Vol.157(2 Supplement), p.AB33
02/2026
DOI: 10.1016/j.jaci.2025.12.103

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Abstract

Rationale Prior studies in chronic spontaneous urticaria (CSU) have shown disparities in care by geography, race, and drug access, but few have examined neighborhood disadvantage or insurance status. This study describes CSU demographics and treatment at a tertiary center and assesses the association of Area Deprivation Index (ADI) and insurance with treatment escalation and continuity of care. Methods We conducted a retrospective chart review of new CSU patients (age >17, ICD-10 L50.1, >2 visits) at a tertiary academic center (2023-2025). Demographics, treatment patterns, drug sample use, and noshow rates were collected. ADI was linked from the Neighborhood Atlas (2000). Insurance was categorized as private, public, or uninsured. Continuous variables were reported as medians (IQR) or means (±SD), and categorical variables as frequencies and percentages. Results Among 165 patients (mean age 44.2 ± 16.0 years; 83.6% female; 75.2% Caucasian) median ADI was 57(37). Most carried private insurance (63%), 34.5% had public insurance, and 2.4% were uninsured. Uninsured patients had higher no-show rates (46% vs 30% private), and higher ADI weakly correlated with fewer visits, although neither reached statistical significance. Overall, 34% (n=57) escalated to omalizumab; median time to decision and first dose were 35(97)and 27(25) days, respectively. Drug samples were used in 20% of omalizumab initiators. Neither ADI nor insurance status significantly predicted omalizumab initiation or timing. Conclusions In this CSU cohort, one third failed antihistamine therapy, with rapid biologic initiation and frequent sample use. Omalizumab access was consistent across ADI and insurance groups, though analyses of antihistamine and immunosuppressant groups are ongoing.

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