Cherrez-Ojeda et al. World Allergy Organization Journal (2021) 14:100542 http://doi.org/10.1016/j.waojou.2021.100542 Open Access How are patients with chronic urticaria interested in using information and communication technologies to guide their healthcare? A UCARE study Ivan Cherrez-Ojedaa,b*, Emanuel Vanegasa,b, Annia Cherrezb,c, Miguel Felixa,b, Karsten Wellerd, Markus Magerld, Rasmus Robin Maurerd, Valeria L. Mataa,b, Alicja Kasperska-Zajace, Agnieszka Sikorae, Daria Fominaf,g, Elena Kovalkovaf, Kiran Godseh, Nimmagadda Dheeraj Raoh, Maryam Khoshkhuii,j, Sahar Rastgooj, Roberta FJ. Criadok, Mohamed Abuzakoukl, Deepa Grandonl, Martijn B. A. Van Doornm, Solange Oliveira Rodrigues Vallen, Eduardo Magalhães De Souza Limao, Simon Francis Thomsenp, German D. Ramónq, Edgar E. Matos Benavidesr, Andrea Bauers, Ana M. Giménez-Arnaut, Emek Kocatürku, Carole Guilletv, Jose Ignacio Larcow, Zuo-Tao Zhaox, Michael Makrisy, Carla Ritchiez, Paraskevi Xepapadakiaa, Luis Felipe Ensinaab, Sofia Cherrezb,ac and Marcus Maurerd ABSTRACT Background: Patients with chronic urticaria (CU) are increasingly using information and communication technologies (ICTs) to manage their health. What CU patients expect from ICTs and which ICTs they prefer remains unknown. We assessed why CU patients use ICTs, which ones they prefer, and what drives their expectations and choices. Methods: In this cross-sectional study, 1841 patients across 17 countries were recruited at UCAREs (Urticaria Centers of Reference and Excellence). Patients with CU who were >12 years old completed a 23-item questionnaire. Results: Most patients were interested in receiving disease information (87.3%), asking physicians about CU (84.1%), and communicating with other patients through ICTs (65.6%). For receiving disease information, patients preferred one-to-one and one-to-many ICTs, especially web browsers. One-to-one ICTs were also the ICTs of choice for asking physicians about urticaria and for communicating with other patients, and e-mail and WhatsApp were the preferred ICTs, respectively. Many-to-many ICTs such as Facebook, Instagram, LinkedIn, and Twitter were least preferred for all 3 purposes. Living in rural areas and higher education were linked to higher odds of being interested in receiving disease information, asking physicians, and communicating with patients through ICTs. Conclusions: Most patients and especially patients with higher education who live in rural areas are interested in using ICTs for their healthcare, but prefer different ICTs for different purposes, ie, a Universidad Espíritu Santo, Samborondón, Ecuador Received 7 January 2021; Received in revised from 26 March 2021; *Corresponding author. Allergy, Immunology & Pulmonary Medicine, Accepted 9 April 2021 Medical and Research Director of Respiralab, Research Professor at Espiritu Online publication date xxx Santo University (UEES), Respiralab, Clinica Kennedy, Seccion Delta, Av 9na. 1939-4551/© 2021 The Author(s). Published by Elsevier Inc. on behalf of Oeste y Av. San Jorg, Ecuador E-mail: ivancherrez@gmail.com World Allergy Organization. This is an open access article under the CC BY- Full list of author information is available at the end of the article NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). http://doi.org/10.1016/j.waojou.2021.100542 2 Cherrez-Ojeda et al. World Allergy Organization Journal (2021) 14:100542 http://doi.org/10.1016/j.waojou.2021.100542 web browsers for obtaining information, e-mail for asking physicians, and WhatsApp for communicating with other patients. Our findings may help to improve ICTs for CU. Keywords: Chronic urticaria, Information and communication technologies, Internet, e-mail, WhatsApp INTRODUCTION much needed in clinical practice and improving clinical outcomes.12,15 Previous studies found Chronic Urticaria (CU) is a skin disorder char- WhatsApp, e-mail, and SMS to be the most acterized by wheals, angioedema, or both, for popular forms of electronic communication for more than 6 weeks.1 The prevalence is receiving and seeking information as well as approximately 1%,2 and a recent systematic communicating with physicians among patients review and meta-analysis reported an overall life- with chronic diseases.16,17 time CU prevalence of 4.4% with Latin America and Asia showing a higher point prevalence than Until very recently, it was largely unknown how other regions.3 Importantly, CU persists for several and why patients with CU use ICTs and their years and results, in many patients, in severely expectations had not been assessed. To address impaired quality of life.4–7 this knowledge gap, the global network of Urti- caria Centers of Reference and Excellence Information and communication technologies (UCAREs)18 performed an international study (ICTs) are used to communicate, manipulate, and and reported first results.19 Specifically, we store data by electronic means. In healthcare, ICTs showed that virtually all CU patients included support the exchange, knowledge transfer, elec- had access to ICTs and very often used these tronic storage, and processing of information to on a daily basis, mostly on a one-to-one and promote health and to manage chronic illnesses one-to-many basis. The use of ICTs for obtaining and treat disease.8,9 These technologies include e- health and CU-specific information was mail, short message service (SMS), text messaging, extremely high in all countries analyzed, with video chat (eg, Skype or Hangouts) and online web browsers being the preferred ICT platform. social media (eg, Facebook or Twitter) as well as These findings were not a surprise given the computing and mobile devices (smartphones high burden of CU; patients seek knowledge and tablets) that perform a wide range of about CU and want to know about its causes, communication and information functions.10 With course, possible trigger factors, and available ICTs, users have worldwide access and are treatment options, as well as prognosis. More- capable of immediate interaction with others, over, this need is mirrored by the fact that CU which was previously not possible. Notably, over patient-physician consultations are particularly the past decade, the usage of ICTs has increased long and frequent.15 dramatically among adolescents and young adults.11 Here, we report on additional study outcomes, focusing on why patients with CU use ICTs, which Given their increasing usage, ICTs have become ones they prefer when retrieving information, and critical for obtaining information from healthcare what drives their expectations and choices. Specif- providers (HCPs) and patients alike.12 Specifically, ically, we assessed their interest in and preference these technologies have become central to patient for ICTs (1) to receive disease information, (2) to ask education, disease self-management, remote physicians about urticaria, and (3) to communicate monitoring of patients, and collection of daily with other CU patients. We also aimed to identify data,13,14 all of which have enhanced healthcare characteristics of those interested/not interested in by creating time/cost efficiencies, which are ICT usage for these purposes. Volume 14, No. 6, Month 2021 3 METHODS participant provided consent to completion of the anonymous survey, and confidentiality was main- Study design and population tained throughout the study. The design and conduct of this study have been previously described in detail.19 Briefly, this was an Statistical analysis anonymous, cross-sectional survey study (see questionnaire in the supplement). Here, we For the purpose of data analyses, ICTs were included additional patients totaling 1841 from grouped into 3 categories:20 primary healthcare centers, university hospitals, 1) one-to-one (dialogic): e-mail, Skype, SMS, and and specialized clinics (either public or private) WhatsApp. that belong to the UCARE network. The healthcare facilities involved were located in Germany, 2) one-to-many (informative): blogs or forums, Argentina, Brazil, China, Denmark, Ecuador, YouTube, and web browsers. Greece, India, Iran, Peru, Poland, Russia, Spain, 3) many-to-many (social): Facebook, Instagram, Switzerland, the Netherlands, the United Arab LinkedIn, and Twitter. Emirates, and Turkey (Supplemental Table S1). Patients were 12 years old and previously diagnosed with chronic spontaneous urticaria In addition, the interest scale was dichotomized (CSU) or chronic inducible urticaria (CIndU) by a as “very-to-extremely interested” (very interested physician. Those with other dermatological and extremely interested) and “not very-to- diseases or intellectual disabilities were excluded. moderately interested” (not interested, slightly interested, and moderately interested). Procedures A 23-item questionnaire, designed, evaluated, A binomial logistic regression analysis was per- and reviewed by an expert panel of physicians formed to predict the likelihood of participants assessed the participants’ interest in (1) receiving being very to extremely interested or not in urticaria information, (2) asking physicians health- receiving information, asking physicians questions, related queries, and (3) communicating with and communicating with other patients through other urticaria patients through specific ICTs. The any ICT category given the effects of age, gender, questionnaire collected demographic (age, education level, geographic area, and years gender, education level, living area, etc) and clin- following diagnosis. All data were analyzed using ical information (urticaria type, years with diag- SPSS version 24.0 software (SPSS Inc., Chicago, IL, nosis, etc.) from each patient. Furthermore, USA). participants were asked to quantify their interest using a scale (not interested, slightly interested, moderately interested, very interested, and RESULTS extremely interested) and specific ICTs (blog or Patient population forum, e-mail, Facebook, Instagram, LinkedIn, Skype, SMS, Twitter, YouTube, web browser, and A total of 1841 urticaria patients were included WhatsApp; questionnaire is contained in the with a female/male gender distribution ratio of Supplement). 2.31 and a mean age of 40.7 years (Table 1). Most patients (81.8%) had CSU, and 36.6% had CIndU (18.6% had both). Most patients had either an Ethical considerations undergraduate degree (35.1%) or secondary This study was approved by the ethics commit- school diploma (32.0%), and half were employed tee “Comité de ética e Investigación en Seres (50.3%). In addition, most participants were Humanos” (CEISH)”, Guayaquil, Ecuador (IRB Europeans (50.7%), followed by Latin Americans number HCK-CEISH-19-0059) and by a committee (26.5%) and Asians (22.8%) (Supplemental for each participating UCARE center. Each Table S1). 4 Cherrez-Ojeda et al. World Allergy Organization Journal (2021) 14:100542 http://doi.org/10.1016/j.waojou.2021.100542 Most CU patients are interested in using ICTs to Web browsers were the highest rated ICT for receive information about their disease and in this purpose, with 44.5% of patients being very or communicating with physicians and other CU extremely interested in their use for receiving CU patients information. Approximately, 9 of 10 patients (87.3%) were interested in the use of ICTs to receive CU in- Only 21.5% of CU patients were very or formation; most were also interested in the use extremely interested in the use of many-to-many of ICTs to ask physicians about CU (84.1%) and ICTs for this purpose. In fact, 60.4% of patients to communicate with other patients (65.6%). were not interested at all in the use of many-to- many ICTs to obtain CU information. Living in ru- CU patients prefer the use of web browsers to ral areas, and higher education presented higher receive information about their disease odds of being interested to receive information through every ICT type (Table 3, Supplemental One-to-many (50.7%) and one-to-one (51.5%) Table S2, and S4A-S4B). ICT category prefer- were the preferred ICT categories for CU patients ences for receiving CU information by country are who were very/extremely interested in receiving shown in Supplemental Table S3. information about their disease (Fig. 1). Characteristics Overall participants (n ¼ 1841) n (%) Age, mean (SD) 40.7 (14.6) Gender Male 556 (30.2) Female 1285 (69.8) Living area Rural 465 (25.3) Urban 1376 (74.7) Education level No education 12 (0.7) Primary/middle school 153 (8.3) Secondary/high school 590 (32.0) Undergraduate/college 647 (35.1) Postgraduate studies 436 (23.7) Employment status Employed 926 (50.3) Self-employed 193 (10.5) Unemployed 90 (4.9) Retired 177 (9.6) Student 222 (12.1) Homemaker 207 (11.2) Disabled 26 (1.4) Urticaria type CSU 1164 (63.2) CIndU 331 (18.0) CSU & CIndU 342 (18.6) Years with diagnosis 3.7 (5.4) Table 1. Demographic and clinical information of surveyed population. CIndU ¼ chronic inducible urticaria; CSU ¼ chronic spontaneous urticaria; SD, standard deviation Volume 14, No. 6, Month 2021 5 CU patients prefer the use of e-mail to ask physi- preferences for ICT category use for communi- cians about urticaria cating with patients. Most CU patients preferred one-to-one ICTs for asking physicians about urticaria (57.6%; Fig. 1). E- mail was the highest rated ICT for this purpose with DISCUSSION 33.8% of patients being very or extremely Previously, we reported that almost all CU pa- interested in its use, followed by web browsers tients have access to ICTs and most use these with 28.7%. regularly for health and disease-related informa- tion.19 Here, we found that most patients with CU Again, living in rural areas and higher education were interested in the use of ICTs for receiving were drivers of high levels of interest in the use of information, asking physicians, and all ICT categories for asking physicians about ur- communicating with other patients about ticaria (Table 3, Supplemental S4A-S4B, S5). urticaria. Of note, patients prefer different ICTs Country-specific ICT category preferences for this for these 3 purposes: web browsers for obtaining purpose are shown in Supplemental Table S6. information; email for asking physicians; and WhatsApp for communicating with other patients. CU patients prefer the use of WhatsApp for ICT- based communication with other patients Obtaining information One-to-one was the preferred ICT category of CU patients who were very or extremely interested Almost all CU patients used ICTs for obtaining in communicating with other patients (33.0%; health and disease-related information.19 One-to Fig. 1). WhatsApp was the highest rated ICT for this many ICTs, specifically web browsers were most purpose with 24.8% of patients being very or frequently used, and the high usage of web extremely interested in its use for communicating browsers by >75% of patients was consistent with with other patients, followed by web browsers other chronic diseases.16,21 Interestingly, one-to- with 19% (Table 2). one ICTs such as email and WhatsApp were also held to be of high interest to patients who are Interest in using almost all ICT categories for looking for information on their urticaria. Fewer communication with other CU patients was driven, patients use email and WhatsApp compared to again, by rural living and higher education web browsers; this may indicate a lack of infor- (Table 3, Supplemental Table S4A-S4B, S7). mation initiatives for these ICTs with a residual Supplemental Table S8 shows country-specific need to develop them. Fig. 1 Frequencies of patients being “very to extremely interested” or “not interested” at all in communicating with other urticaria patients, asking, and receiving information about urticaria through each ICT category. ICT ¼ Information and communication technologies. Note: many-to-many ICTs (Facebook, Instagram, LinkedIn, and Twitter), one-to-many (blogs or forums, YouTube, and web browsers), and one-to- one (e-mail, Skype, SMS, and WhatsApp) 6 Cherrez-Ojeda et al. World Allergy Organization Journal (2021) 14:100542 http://doi.org/10.1016/j.waojou.2021.100542 Not Slightly Moderately Very Extremely interested interested interested interested interested n (%) n (%) n (%) n (%) n (%) Interest in receiving information through ICTs Many-to-many Facebook 1235 20 (1.1%) 201 (10.9%) 211 83 (4.5%) (67.1%) (11.5%) Instagram 1513 19 (1.0%) 91 (4.9%) 90 (4.9%) 76 (4.1%) (82.2%) LinkedIn 1711 18 (1.0%) 22 (1.2%) 35 (1.9%) 10 (0.5%) (92.9%) Twitter 1669 18 (1.0%) 49 (2.7%) 36 (2.0%) 13 (0.7%) (90.7%) One-to-many Blog/forum 1526 12 (0.7%) 81 (4.4%) 91 (4.9%) 79 (4.3%) (82.9%) Web browser 600 9 (0.5%) 323 (17.5%) 524 295 (16.0%) (32.6%) (28.5%) YouTube 1209 15 (0.8%) 179 (9.7%) 209 160 (8.7%) (65.7%) (11.4%) One-to-one E-mail 833 16 (0.9%) 216 (11.7%) 332 296 (16.1%) (45.2%) (18.0%) Skype 1690 27 (1.5%) 32 (1.7%) 31 (1.7%) 15 (0.8%) (91.8%) SMS 1221 24 (1.3%) 171 (9.3%) 152 99 (5.4%) (66.3%) (8.3%) WhatsApp 1060 22 (1.2%) 156 (8.5%) 294 231 (12.5%) (57.6%) (16.0%) Interest in asking physicians about urticaria through ICTs Many-to-many Facebook 1307 15 (0.8%) 183 (9.9%) 150 72 (3.9%) (71.0%) (8.1%) Instagram 1568 15 (0.8%) 75 (4.1%) 78 (4.2%) 44 (2.4%) (85.2%) LinkedIn 1717 7 (0.4%) 54 (2.9%) 13 (0.7%) 7 (0.4%) (93.3%) Twitter 1694 20 (1.1%) 33 (1.8%) 43 (2.3%) 9 (0.5%) (92.0%) One-to-many Blog/forum 1549 12 (0.7%) 83 (4.5%) 87 (4.7%) 54 (2.9%) (84.1%) Web browser 868 11 (0.6%) 294 (16.0%) 333 195 (10.6%) (47.1%) (18.1%) YouTube 1392 14 (0.8%) 161 (8.7%) 83 (4.5%) 54 (2.9%) (75.6%) (continued) Volume 14, No. 6, Month 2021 7 Not Slightly Moderately Very Extremely interested interested interested interested interested n (%) n (%) n (%) n (%) n (%) One-to-one E-mail 814 10 (0.5%) 309 (16.8%) 341 281 (15.3%) (44.2%) (18.5%) Skype 1509 27 (1.5%) 71 (3.9%) 63 (3.4%) 32 (1.7%) (82%) SMS 1227 21 (1.1%) 135 (7.3%) 218 114 (6.2%) (66.6%) (11.8%) WhatsApp 849 21 (1.1%) 182 (9.9%) 390 325 (17.7%) (46.1%) (1.2%) Interest in communicating with other urticaria patients through ICTs Many-to-many Facebook 1242 26 (1.4%) 196 (10.6%) 159 106 (5.8%) (67.5%) (8.6%) Instagram 1588 26 (1.4%) 66 (3.6%) 61 (3.3%) 54 (2.9%) (86.3%) LinkedIn 1724 10 (0.5%) 31 (1.7%) 27 (1.5%) 6 (0.3%) (93.6%) Twitter 1691 20 (1.1%) 34 (1.8%) 21 (1.1%) 34 (1.8%) (91.9%) One-to-many Blog/forum 1510 11 (0.6%) 96 (5.2%) 103 58 (3.2%) (82.0%) (5.6%) Web browser 1119 25 (1.4%) 184 (10.0%) 193 157 (8.5%) (60.8%) (10.5%) YouTube 1489 18 (1.0%) 87 (4.7%) 96 (5.2%) 51 (2.8%) (80.9%) One-to-one E-mail 1131 27 (1.5%) 257 (14.0%) 181 133 (7.2%) (61.4%) (9.8%) Skype 1604 35 (1.9%) 52 (2.8%) 59 (3.2%) 21 (1.1%) (87.1%) SMS 1321 17 (0.9%) 182 (9.9%) 97 (5.3%) 74 (4.0%) (71.8%) WhatsApp 1083 25 (1.4%) 204 (11.1%) 253 204 (11.1%) (58.8%) (13.7%) Table 2. (Continued) Distribution of participants per degree of interest in using individual ICTs for health-related purposes. ICT ¼ nformation and communication technologies; SMS ¼ short message service. Notes: Due to missing data in some answers, adding up the percentages for specific ICTs or categories may not add up to 100% Asking physicians for asking physicians questions about their disease, e-mail was consistently rated very high.23,24 In Email is a unique one-to-one addition to the multiple studies, young and highly educated conventional methods of consultation, one which patients were more interested in using email to improves communication and enhances manage- communicate with their HCPs.25,26 Our findings ment of chronic diseases.22 In chronic diseases, were consistent with the aforementioned results. when patients were asked which ICTs they prefer 8 Cherrez-Ojeda et al. World Allergy Organization Journal (2021) 14:100542 http://doi.org/10.1016/j.waojou.2021.100542 Interest in asking Interest in receiving Interest in communicating physicians about urticaria Variable information through with other patients through through ICT type OR (95% ICT type OR (95% CI) ICT type OR (95% CI) CI) Many-to-many Age 0.98 (0.97–0.98) 0.97 (0.97–0.98) 0.96 (0.95–0.97) Living area Urban 0.75 (0.57–0.97) 0.71 (0.54–0.95) 0.62 (0.47–0.81) Education level Undergraduate 2.25 (1.34–3.79) 1.65 (0.99–2.75) 1.63 (0.96–2.75) studies Postgraduate 1.97 (1.14–3.39) 1.36 (0.80–2.34) 1.81 (1.05–3.13) studies One-to-Many Age 0.98 (0.97–0.98) 0.99 (0.98–0.99) 0.97 (0.97–0.98) Years with urticaria 1.03 (1.01–1.05) 1.00 (0.98–1.02) 1.00 (0.99–1.03) Living area Urban 0.88 (0.70–1.10) 0.64 (0.51–0.81) 0.63 (0.49–0.81) Education level Secondary/ 2.74 (1.84–4.01) 2.00 (1.28–3.13) 2.22 (1.32–3.72) Highschool Undergraduate/ 4.18 (2.80–6.23) 2.90 (1.87–4.51) 3.18 (1.91–5.30) college Postgraduate 2.39 (1.58–3.62) 1.93 (1.22–3.07) 2.36 (1.38–4.03) studies One-to-One Age 0.99 (0.98–0.99) 0.99 (0.98–0.99) 0.99 (0.98–0.99) a Living area Urban 0.61 (0.48–0.77) 0.78 (0.63–0.99) 0.90 (0.71–1.14) Education levelb Secondary/ 2.36 (1.60–3.47) 2.05 (1.41–2.97) 1.71 (1.14–2.67) Highschool Undergraduate/ 3.45 (2.34–5.08) 3.59 (2.47–5.23) 2.02 (1.32–3.08) college Postgraduate 2.34 (1.57–3.49) 3.02 (2.04–4.47) 2.21 (1.43–3.42) studies Table 3. Characteristics of ICT users reporting to be very or extremely interested in receiving urticaria information, asking physicians about urticaria and communicating with other urticaria patients through ICT type. Notes many-to-many ICTs (Facebook, Instagram, LinkedIn and Twitter), one-to-many (blogs or forums, YouTube and web browsers), and one-to-one (e-mail, Skype, SMS and WhatsApp). Regression analyses were adjusted for variables such as age, gender, education level, living area and years with urticaria. Bolded values are significant at 0.05 significance level. OR, odds ratio; CI, confidence interval a. Reference living area is “rural” b. Reference education level category is “No education/Primary school” Volume 14, No. 6, Month 2021 9 Communication with other CU patients outcomes to help assess disease severity and course, particularly during the current pandemic. WhatsApp is the most popular global mobile New ICTs should be user friendly. Techno- messenger application and is cost-effective, fast, complexity has negative consequences and reliable, and easy to use. In a literature review, would ultimately lead to nonadherence and WhatsApp was shown to be an effective tool for greater stress in all age groups, particularly the both communication and learning between HCPs elderly.31 In all, new ICTs could provide patients and the general public.27 Many physicians have with optimized, tailored disease information and incorporated WhatsApp into their everyday communications which would ultimately improve practice, given its practical advantages.28 CU management and outcomes. Moreover, at UCARE centers, we have observed a 50% increase in the usage of WhatsApp during the COVID-19 pandemic in our clinics.19 Strengths and limitations It is the second most frequently used ICT Our study included participants of different following cell phones.19 In our study, WhatsApp ages, genders, and education levels across many rated very high for communication with other regions. Moreover, our network had the capacity CU patients. This information may help patient to obtain a high sample globally. However, there organizations to make use of this ICT in were study limitations. The study design was cross- connecting CU patients. sectional and therefore cause-and-effect relation- ships could not be detected. Our 23-item survey Usage of ICTs among different groups has not been validated. Participants knew the purpose of this study in advance. In addition, Usage of ICTs differed depending on age, living accessibility of ICTs varies between countries. area, and educational level. Younger age was a Given the high rate of EU participants, differences significant predictor of high interest (very/ between countries/continents could not be extremely) in the usage of every ICT type for the 3 detected. Randomized trials are necessary to specific purposes studied. Similar results have determine the efficacy and cost effectiveness of been reported where younger generations had the new ICT tools in promoting CU control as well as highest overall ICT usage compared to older providing sources of information about disease cohorts.17 and self-management. We expected lower levels of ICT usage in countries that were highly regulated such as Iran; however, we found that Argentina had lower us- CONCLUSIONS age, too. Given limited access to specialists in rural While a number of ICT types have become areas, ICTs could be useful, especially in devel- universal in modern medical practice, the results of oping countries where there is evidence that ICT our study demonstrated that one-to-one and one- usage helps to prevent disease.29 to-many ICTs were the most preferred types for CU Predictably, higher levels of education were patients to receive disease information and to associated with increased ICT usage for the 3 areas communicate with their physicians and other pa- studied. While data suggest women use social tients. Urticaria specialists and accredited centers networks more than men,30 we did not find any could, in coordination with ICT designers, intro- difference in ICT usage between genders even duce personalized technological solutions for each though the prevalence of CU is higher in women, patient. Additionally, feedback loops could be in- which was confirmed by our results. tegrated to improve tailoring and allow content to be adapted to changing needs. The future Abbreviations Results here support the development of vali- ICT: information and communication technologies; CU: dated disease content for easy-to-use ICTs that are chronic urticaria; CSU: chronic spontaneous urticaria; CU-specific, focus on one-to-one and one-to-many CIndU: chronic inducible urticaria; HCP: healthcare communication, and include patient-reported providers; SMS: short message service. 10 Cherrez-Ojeda et al. World Allergy Organization Journal (2021) 14:100542 http://doi.org/10.1016/j.waojou.2021.100542 Ethics statement Lilly, Janssen, LEO Pharma, Novartis, Pierre Fabre, Roche, The authors declare that this manuscript complies with the Sanofi, and UCB. GD Ramón has no conflicts of interest. EE ethics in publishing guidelines. This study was approved by Matos Benavides has no conflicts of interest. A Bauer is or the ethics committee “Comité de ética e Investigación en recently was a speaker and/or advisor for, and/or has Seres Humanos” (CEISH)”, Guayaquil, Ecuador (IRB number received research funding from Novartis, Sanofi, Gen- HCK-CEISH-19-0059) and by a committee for each entech, Leo Pharma and Shire/Takeda. Ana M Giménez- participating UCARE center. Each participant provided Arnau has held roles as a Medical Advisor for Sanofi, consent to completion of the anonymous survey, and Uriach, Genentech, Novartis, Amgen , ThemoFisher, Roche, confidentiality was maintained throughout the study. Almirall, and has research grants supported by Instituto Carlos III- FEDER, Novartis, and Uriach; she also partici- pates in educational activities for Almirall, Genentech, Author contributions Glaxo SmithKline, LEO Pharma, Menarini, MSD, Novartis, All authors declare that they have made substantial Sanofi, Avene and Uriach. E Kocatürk is or recently was a contributions to conception and design, acquisition of speaker and/or advisor for Bayer, Novartis, and Sanofi. C data, or analysis and interpretation of data; drafted the Guillet has no conflicts of interest. JI Larco is or recently article or reviewed it critically for important intellectual was a speaker and/or advisor for: FAES, Novartis, and content; and given final approval of the version to be Sanofi. Z-T Zhao has no conflicts of interest. M Makris is or published. recently was a speaker and/or advisor for, and/or has received research funding from AstraZeneca, Chiesi, Glaxo SmithKline, Novartis, and Sanofi. C Ritchie has no conflicts Funding statement of interest. P Xepapadak reports personal fees from This study was funded by the network of urticaria centers of Galenica Greece, Glaxo SmithKline, Nestle, Novartis, reference and excellence (UCARE, www.ga2len-ucare.com) Nutricia, and Uriach, outside the submitted work. LF Ensina and supported by the World Allergy Organization (WAO), is or recently was a speaker and/or advisor for, and/or has who played no role in the development of this MS. received research funding from Novartis, Sanofi, and Takeda. S Cherrez has no conflicts of interest. M Maurer is or recently was a speaker and/or advisor for, and/or has Availability of data and materials received research funding from: Allakos, Alnylam, Aralez, All study materials and data were available to all study AstraZeneca, Biocryst, Blueprint, CSL Behring, FAES, Gen- centers and physicians. entech, Kalvista Pharmaceuticals, LEO Pharma, Menarini, Declaration of competing interest Moxie, MSD, Novartis, Pharming, Pharvaris, Roche, Sanofi, I Cherrez-Ojeda has no conflicts of interest. E Vanegas Shire/Takeda, UCB, and Uriach. has no conflicts of interest. A Cherrez has no conflicts of Acknowledgements interest. M Felix has no conflicts of interest. K Weller is or We wish to thank Leonard Lionnet, PhD, CMPP for medical recently was a speaker and/or advisor for, and/or has writing and editorial assistance. This project benefitted received research funding from: Biocryst, CSL Behring, Dr. from the support of the GA2LEN network of urticaria Pfleger, FAES, Moxie, Novartis, Shire/Takeda, and Uriach. centers of reference and excellence (UCARE, www.ga2len- M Magerl is or recently was a speaker and/or advisor for, ucare.com) and the World Allergy Organization (WAO). and/or has received research funding from Biocryst, CSL Finally, we want to express our gratitude to Universidad Behring, Kalvista Pharmaceuticals, Moxie, Novartis, Espiritu Santo for their continuous support. Pharming, and Shire/Takeda. RR Maurer has no conflicts of interest. VL Mata has no conflicts of interest. A Kasperska- Zajac has no conflicts of interest. A Sikora has no conflicts Appendix A. Supplementary data of interest. D Fomina is or recently was a speaker and/or Supplementary data to this article can be found online at advisor for, and/or has received research funding from: https://doi.org/10.1016/j.waojou.2021.100542. AstraZeneca, CSL Behring, Glaxo SmithKline, MSD, Novartis, Sanofi, and Shire/Takeda. E Kovalkova has no Author details a conflicts of interest. K Godse has no conflicts of interest. N Universidad Espíritu Santo, Samborondón, Ecuador. b Dheeraj Rao has no conflicts of interest. M Khoshkhui has Respiralab, Respiralab Research Group, Guayaquil, no conflicts of interest. S Rastgoo has no conflicts of Ecuador. cClinic and Policlinic for Dermatology and interest. RFJ Criado has no conflicts of interest. Venereology, University Medical Center Rostock, Rostock, M Abuzakouk has no conflicts of interest. D Grandon has Germany. dDermatological Allergology, Allergie-Centrum- no conflicts of interest. MBA van Doorn is or recently was a Charité, Department of Dermatology and Allergy, Charité - speaker and/or advisor for, and/or has received research Universitätsmedizin Berlin, Germany. eEuropean Center for funding from Abbvie, BMS, Celgene, Janssen Cilag, LEO Diagnosis and Treatment of Urticaria, Medical University of Pharma, Lilly, MSD, Novartis, Pfizer, and Sanofi-Genzyme. S Silesia, Katowice, Poland. fCity Center of Allergy and Valle has no conflicts of interest. E Magalhães de Souza Immunology, Clinical City Hospital #52, Moscow, Russia. g Lima has no conflicts of interest. SF Thomsen is or recently Department of Allergology and Clinical Immunology, I.M. was a speaker and/or advisor for, and/or has received Sechenov First Moscow State Medical University, research funding from: Abbvie, AstraZeneca, Celgene, Eli Trubetskaya St., 8/2, Moscow, 119991, Russian Federation. Volume 14, No. 6, Month 2021 11 h Department of Dermatology, D Y, Patil University School 6. 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