The following is a summary of “Do regional geography and race influence management of chronic spontaneous urticaria?” published in the December 2022 issue of the Allergy and Clinical Immunology by Mosnaim, et al.

Migrating, evanescent, pruritic, blanching wheals that develop with varying frequency for 6 weeks or more, with or without angioedema, are the hallmark of chronic spontaneous urticaria. Somewhere between 0.1% and 1.4% of the global population has this disorder. The most common treatment is a second-generation H1 antihistamine, but other choices include H2 antihistamines, leukotriene receptor antagonists, glucocorticoids, immunosuppressive drugs, and omalizumab, which may be used for refractory cases. 

However, the degree of practice diversity regarding what therapies are recommended needs to be better understood. Clinical care could be driven by patient preferences or lack of clarity regarding best practices for refractory cases. Researchers conducted a pilot study to investigate whether or not differences in the prescription of treatment for chronic spontaneous urticaria exist based on the patient’s race, ethnicity, and proximity to a specialist. In a broad Chicago-area healthcare network, they found that treatment for persistent spontaneous urticaria varied significantly across tiny geographic areas. 

There was a correlation between patient zip code and omalizumab prescription rates, with higher rates of omalizumab prescriptions being linked to zip codes that were physically closer to the main office of an academic medical center-affiliated allergist-immunologist practice. Regional and patient-level analyses also found that Whites were more likely to utilize omalizumab, but the reasons for this racial disparity remain unclear.