Emergency department utilization in patients with chronic spontaneous urticaria followed at a tertiary referral center: A retrospective cross-sectional study

Abstract

Background: Chronic spontaneous urticaria (CSU) frequently prompts emergency department (ED) visits, but few studies have characterized this utilization in a defned dermatology cohort under contemporary anti-IgE therapy. Objective: To quantify ED utilization, identify factors associated with prior ED visits, and describe the pattern of ED-initiated dermatology consultation in adult CSU patients at a tertiary referral center. Methods: Retrospective cross-sectional analysis of 195 adult patients with physician-diagnosed CSU at a single tertiary der matology clinic between June 1,2025, andDecember31,2025.ThreeoperationalEDutilization rates wereestimated. Patients with at least one prior ED visit were compared with patients without, and a multivariable logistic regression model was constructed. Results: Median age was 43years (Q1–Q3: 36–51); 66.2% were female; angioedema was reported in 24.1% and omalizumab prescribed in 97.9%. The ED served as the initial point of contact in 5.1% (95% confdence interval [CI]: 2.8%–9.2%); 45.1% (95% CI: 38.3%–52.1%) had any prior ED visit and 26.2% (95% CI: 20.5%–32.7%) had recurrent visits. Among ED users, antihistamines were administered in 93.2% andsystemic corticosteroids in 59.1%, while ED-initiated dermatology consultation was documented in only 8.0% (95% CI: 3.9%–15.5%). In multivariable analysis, concomitant angioedema was independently associated with prior ED utilization (adjusted OR: 3.99, 95%CI:1.93–8.69, p < 0.001);identifabletrigger wasinverselyassociated (adjustedOR:0.36, 95%CI: 0.14–0.88, p = 0.025). Conclusions: Even though omalizumab had been prescribed in 97.9% of the patients, almost half had attended the ED and consultation occurred in fewer than one in ten ED users. Concomitant angioedema independently predicts ED utilization, and ED encounters represent a missed integration point in CSU longitudinal care.