{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:04:13Z","timestamp":1789643053568,"version":"4.0.0"},"reference-count":16,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Chronic Spontaneous Urticaria (CSU) profoundly impairs health-related quality of life due to intense pruritus and unpredictable flares. However, its specific influence on patients\u2019 major life-changing decisions (MLCD)\u2014such as career choices, family planning, and personal relationships\u2014remains under-researched. This study aimed to evaluate the overall impact of CSU on MLCD and analyze how disease severity modifies these fundamental life trajectories. Methods: This exploratory, cross-sectional study included adult patients with active CSU (\u22656 months\u2019 duration) consecutively recruited from a tertiary hospital. Clinical data were collected, and disease activity was captured via the validated patient-reported Urticaria Activity Score over 7 days (UAS7), categorizing patients as having severe (UAS7 \u2265 28) or mild-to-moderate (UAS7 &lt; 28) disease activity. A 4-point Likert scale adapted from the conceptual framework by Bhatti et al. was used to assess the perceived impact across multiple life-changing decision domains. Results: Thirty patients were evaluated (mean duration 5.6 years; mean UAS7 30.47). CSU substantially impacted MLCD, particularly lifestyle habits (70%), work performance (63.3%), domestic travel\/leisure (60%), and clothing choices (60%). Patients with severe CSU reported a markedly higher impairment in professional career choices (52.6% vs. 25.0%, p = 0.030), work performance (84.2% vs. 37.5%, p = 0.036), educational attainment (25.0% vs. 0.0%, p = 0.038), family relationships (71.5% vs. 11.1%, p = 0.022), and lifestyle habits (90.5% vs. 22.2%, p = 0.002) compared to those with mild-to-moderate disease. Conclusions: In this exploratory cohort, CSU was associated with substantial impairments in patients\u2019 MLCD, with a higher frequency of disruption observed among those with severe disease activity. These findings highlight the value of adopting a biopsychosocial perspective in clinical practice to support life trajectories alongside cutaneous symptom control.<\/jats:p>","DOI":"10.3390\/jcm15187222","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T09:59:03Z","timestamp":1789639143000},"page":"7222","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Chronic Spontaneous Urticaria on Major Life-Changing Decisions: An Exploratory Cross-Sectional Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Luc\u00eda","family":"Fuentes-Barrag\u00e1n","sequence":"first","affiliation":[{"name":"Department of Biochemistry and Molecular Biology III and Immunology, University of Granada, 18016 Granada, 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Study","volume":"67","author":"Maheshwari","year":"2022","journal-title":"Indian J. Dermatol."},{"key":"ref_3","first-page":"717","article-title":"Acute and Chronic Urticaria: Evaluation and Treatment","volume":"95","author":"Schaefer","year":"2017","journal-title":"Am. Fam. Physician"},{"key":"ref_4","first-page":"80","article-title":"Assessment of severity and quality of life in chronic urticaria","volume":"24","author":"Jauregui","year":"2014","journal-title":"J. Investig. Allergol. Clin. Immunol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1111\/all.14037","article-title":"Prevalence of chronic urticaria in children and adults across the globe: Systematic review with meta-analysis","volume":"75","author":"Fricke","year":"2020","journal-title":"Allergy"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Sanchez-Diaz, M., Rodriguez-Pozo, J.A., Latorre-Fuentes, J.M., Salazar-Nievas, M.C., Alejandro, M.L., and Arias-Santiago, S. (2023). Sleep Quality as a Predictor of Quality-of-Life and Emotional Status Impairment in Patients with Chronic Spontaneous Urticaria: A Cross-Sectional Study. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20043508"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1258\/jrsm.2011.110010","article-title":"Chronic diseases influence major life changing decisions: A new domain in quality of life research","volume":"104","author":"Bhatti","year":"2011","journal-title":"J. R. Soc. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/1477-7525-11-78","article-title":"The development and validation of the Major Life Changing Decision Profile (MLCDP)","volume":"11","author":"Bhatti","year":"2013","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"adv11640","DOI":"10.2340\/actadv.v103.11640","article-title":"Factors Influencing Major Life-Changing Decisions in Patients with Psoriasis: A Cross-sectional Study","volume":"103","year":"2023","journal-title":"Acta Derm. Venereol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1111\/bjd.19561","article-title":"The global burden of chronic urticaria for the patient and society","volume":"184","author":"Goncalo","year":"2021","journal-title":"Br. J. Dermatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"22799036241243268","DOI":"10.1177\/22799036241243268","article-title":"Does chronic urticaria affect quality of sleep and quality of life?","volume":"13","author":"Awad","year":"2024","journal-title":"J. Public Health Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"185","DOI":"10.3904\/kjim.2015.195","article-title":"Disease-specific impairment of the quality of life in adult patients with chronic spontaneous urticaria","volume":"33","author":"Choi","year":"2018","journal-title":"Korean J. Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s00403-020-02064-3","article-title":"The association of chronic spontaneous urticaria (CSU) with anxiety and depression: A nationwide cohort study","volume":"313","author":"Berzin","year":"2021","journal-title":"Arch. Dermatol. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"adv00161","DOI":"10.2340\/00015555-3511","article-title":"Counting the Burden: Atopic Dermatitis and Health-related Quality of Life","volume":"100","author":"Ali","year":"2020","journal-title":"Acta Derm. Venereol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.clindermatol.2018.05.012","article-title":"Assessing the severity of atopic dermatitis in clinical trials and practice","volume":"36","author":"Chopra","year":"2018","journal-title":"Clin. Dermatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"adv42241","DOI":"10.2340\/actadv.v105.42241","article-title":"Impact on Major Life-changing Decisions in Patients with Atopic Dermatitis","volume":"105","year":"2025","journal-title":"Acta Derm. 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