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If you're being treated for hives, your physician will want to hear what you think about your treatment. Is it working? Are your symptoms improving, staying the same, or getting worse? You may be asked to fill out a couple of questionnaires, known as patient-reported outcome measures or PROMs, at each visit.

PROMs can be used to assess chronic spontaneous urticaria, or CSU, a common type of chronic hives with red, raised itchy bumps or wheals that last for 6 weeks or longer. PROMs are also used to assess swelling in the deeper tissues of the face and neck -- the eyes, lips, tongue, and throat -- as well as on the hands and feet. This is called "angioedema" and it develops in about 40% of people who have hives.

What kinds of questions do PROMs ask?

PROMs ask questions about hives symptoms such as itchiness, how well treatment is controlling symptoms, and the impact that symptoms may be having on your everyday life. Perhaps you've been experiencing itch that gets worse at night and now the loss of sleep is interfering with your daytime activities. Maybe you've become self-conscious about your appearance and feel like skipping school, taking a day off from work, or not attending a social event. Maybe you're feeling anxious, even depressed. This is how hives can affect your quality of life and PROMs are used to assess this too.

Don't dismiss filling out the questionnaires as something you don't have time for. Your perspective is vitally important to the success of your treatment. PROMs are valuable tools that help you and your doctor fine-tune treatment, which is key to reclaiming your life.

"I would say the best way to improve quality of life is getting CSU under control," said Chris G. Adigun, MD, of the Dermatology and Laser Center of Chapel Hill in North Carolina.

How long will treatment take?

The Urticaria Control Test (UCT) is one of the most commonly used PROMs and asks the following four questions:

• How severe are your physical symptoms?

• What effect are the symptoms having on your everyday life?

• How well does treatment control the symptoms?

• How often does treatment fail to control your symptoms?

What do the scores mean?

UCT scores range from 0 to 16, with 0 indicating no control of hives symptoms, 1-11 points indicating poor control, and 12-16 indicating good control.

What about other PROMs?

There are many PROMs to assess treatment of hives and angioedema, including:

• The Urticaria Activity Score or UAS, used to assess symptoms such as itch on either a daily or weekly basis. In the weekly version, UAS7, scores range from 0 to 42 points, from no symptoms of hives (0) to severe hives (28-42).

• The Angioedema Control Test or AECT also has four questions, and two versions evaluate swelling in either the last 4 weeks or last 3 months. A score of 10 on both AECTs indicates excellent disease control.

• The Chronic Urticaria Quality of Life Questionnaire or CUQ2oL measures how CSU is affecting day-to-day life. The questions ask about itch, swelling, sleep, and daily activities, and answers are scored from 1 to 5. The higher the score, the greater the impact of hives.

• The Dermatology Life Quality Index or DLQI is another questionnaire used to evaluate the impact of skin disease, because patients with other skin conditions, such as psoriasis and eczema, can also use it. The questions ask about symptoms, social activities, work/school life, personal relationships, and treatment, with a total score ranging from 0 to 30. Again, the higher the score, the more hives are affecting everyday life.

Additional Resources:

Read previous installments in this series:

For Your Patients: All About Hives

For Your Patients: Understanding the Many Different Types of Hives

For Your Patients: How Will My Doctor Diagnose Hives?

For Your Patients: What's the Best Treatment for Hives?

For Your Patients: Is Stress Causing My Hives?

For Your Patients: Is It Safe to Treat Hives During Pregnancy?

For Your Patients: Help! My Child Has Hives

For Your Patients: What's Causing My Chronic Hives?

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.