Urticaria is considered a heterogeneous group of diseases which share a distinct skin reaction pattern i.e. the development of urticarial wheals and/or angioedema [1]. A wheal consists of three typical features; a central swelling of variable size almost invariably surrounded by a reflex erythema, associated itching or sometimes burning sensation and a short lasting nature usually for 1–24hours. Angioedema is characterized by sudden, pronounced swelling of the lower dermis and subcutis, sometimes associated with pain rather than itching, and frequent involvement of mucous membranes. The resolution is slower than that for wheals and can take up to 72 hours [2].

Urticaria affects 15-20% of the population at least once or more during a lifetime. Recurrences are common for months or years in around 30% patients of urticarial [3].

Urticaria is a clinical reaction pattern triggered by many factors causing the liberation of vasoactive substances such as histamine, prostaglandins and kinins. Clinically, uritcaria is classified as acute urticaria when the wheals are lasting for <6 weeks [4]. On the other hand, wheals and/or angioedema lasting for a period of longer than 6 weeks is classified as chronic urticaria leading to significant psychological morbidity and poor quality of life [3,5]. Females are affected more commonly than males [3,6].

Establishing the cause of chronic urticaria is often difficult and at times almost impossible. Autoimmunity, medications, contactants, stress, physical factors (physical urticaria) and infections are often considered causative for urticaria. However, most cases of chronic urticaria remain idiopathic [7].

There is scarce information on the Socio-demographic characteristics of patients suffering from Chronic Spontaneous Urticaria in Himachal Pradesh. Therefore present study was done to evaluate the socio-demographic characteristics of patients with Chronic Spontaneous Urticaria             

Aims and Objectives

To evaluate the socio-demographic characteristics of patients with Chronic Spontaneous Urticaria

• Research Approach: Descriptive

• Research Design: Hospital based Cross-sectional survey design

• Study Area: OPD of Dermatology, Venereology & Leprosy clinic of Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh

• Study Duration: Between April 2016 and March 2017

• Study Population: Patients of Chronic Spontaneous Urticaria

• Sample Size: All 100 consecutive patients of chronic Spontaneousurticaria aged 18 years and above attending the outpatient Dermatology, Venereology and Leprosy clinic of Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh between April 2016 and March 2017 were enrolled for the study

• Inclusive Criteria: who were willing to participate in the study

Exclusion Criteria

• Patients suffering from physical urticaria, urticarial vasculitis, or acute urticaria

• Patients younger than 18 years of age

• Pregnant and lactating women

• Patients taking medications that can influence the coagulation/fibrinolysis pathway (asprin, clopidogrel, warfarin, heparin)

• Study Tool: A self designed, close ended questionnaires consisting of socio-demography, symptoms, duration, previous medical history etc. was created 

• Validity of Tool: by the experts in this field

• Data Collection: Data was collected under the guidance of supervisors. The demographic profile, age, sex, occupation, place of residence, duration and evolution of urticaria, personal and family history, detailed medical history and clinical details of urticaria were recorded on a pre-designed proforma. Physical urticaria was excluded on the basis of thorough clinical history/examination and provocation tests. A clinical examination and investigations were performed to exclude systemic diseases/infections known to cause urticaria

• Data Analysis: Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage, mean standard deviation etc

• Ethical Considerations: The study was conducted after approval from Institutional Protocol Review Board and Institutional Ethics Committee. The patients were enrolled only after informed consent and after clarifying their queries regarding the study. Participant’s confidentiality and anonymity was maintained

The study comprised 100 consecutive patients with chronic Spontaneousurticaria and had 25 males and 75 females M: F = 1:3 aged between 18 and 69 Mean±SD = 36.12±10.88 years. Thirty-seven 37% patients were aged less than or equal to 30 years and 9 patients were more than 50 years of age. The majority, 68 68% patients were aged between 18-40 years followed by 23 23% patients in the age group of 41-50 years (Table 1).

The age at onset of urticaria ranged from 3 to 69 Mean±SD = 33.53±11.36 years and 84(84%) patients started having urticaria at 21–50 years of age (Table 2).

The duration of urticaria varied between 6 weeks and 240 median±IQR 6±9 months (Table 3). The majority, 85 85% patients had urticaria for less than 12 months (Table 3).

31(31%) patients in had past episodes of urticaria. Frequency of episodes per year varied between 10 to120 among patients (Table 4).

Table 1: Age and Gender Distribution of Patients

Table 2: Age at Onset of Chronic Urticaria

Table 3: Duration of Chronic Urticaria

Table 4: Previous Episodes of Urticaria& Its Frequency per Year

Chronic urticaria with urticarial wheals and/or angioedema for more than 6 weeks affects 15-20% of the population at least once during a lifetime and its onset in most adults is between 20 and 40 (mean 33) years of age [6,8]. Females are affected more often than males.³ The demographic profile of 100 patients in this study also corroborates. They comprised 25 males and 75 females (M: F = 1:3) aged between 18 to 69 (mean±SD = 36.12±10.88) years. The majority, 68(68%) patients were aged 18-40 years and females outnumbered males by three times. The majority, 68 (68%) patients were aged between 18-40 years followed by 23 (23%) patients in the age group of 41-50 years. 

The age at onset of urticaria ranged from 3 to 69 (mean±SD = 33.53±11.36) years and 84 (84%) patients started having urticaria at 21–50 years of age.The duration of urticaria varied between 6 weeks and 240 (median±IQR 6±9) months (Table-3). The majority, 85 (85%) patients had urticaria for less than 12 months. 31 (31%) patients in had past episodes of urticaria. Frequency of episodes per year varied between 10 to 120 among patients.

Similar to our study, in the study done by Maria Regina CavarianiSilvares et al. [9], chronic urticaria-angioedema occurred mainly in females (mean age: 35 years), but also in men (mean age: 32 years). White color and living in urban areas also predominated. There was no preferential time for symptoms to appear, and night time was the most commonly reported time for clinical worsening.

It was possible to conclude that chronic urticaria-angioedema occurred mainly among middle-aged women. It is a long-term disease as the average duration of the disease was long about 6 to 9 months and many patients had past episodes of urticaria

Limitations

Small number of patients, lack of treatment outcome measures, and unavailability of specific parameters to determine coagulation pathway activation, and a cross-sectional nature of study are some of the limitations of this study.

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