UAS7 Questionnaire
UAS7 Questionnaire
UAS7 Questionnaire
UAS7:
A tool to assess
disease activity
in patients with CIU
Chronic idiopathic urticaria (CIU) is a skin disorder
characterized by the spontaneous appearance of
wheals and/or angioedema for at least 6 weeks.1
Please remind patients to bring their completed questionnaires to their next visit.
Patient name:
Physician name:
Date:
Weekly Urticaria
Date
Example
Daily intensity
of pruritus
+
+
! 0
= !0
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
UAS7 score
Wheals
Pruritus
None
None
Mild
(less than 20 wheals/24hours)
Mild
(present but not annoying or troublesome)
Moderate
(20-50 wheals/24hours)
Moderate
(troublesome but does not interfere
with normal daily activity or sleep)
Intense
(more than 50 wheals/24hours or large
confluent areas of wheals)
Intense
(severe pruritus, which is sufficiently
troublesome to interfere with normal
daily activity or sleep)
Remember to complete this questionnaire for your next visit with your doctor.
References: 1. Zuberbier T, Asero R, Bindslev-Jensen C et al. EAACI/GA2LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy 2009 Oct;64(10):1417-26.
2. Khan DA. Chronic urticaria: Standard management and patient education. In: UpToDate, Waltham, MA. Available at http://www.uptodate.com/contents/chronic-urticaria-standardmanagement-and-patient-education?topicKey=ALLRG%2F8106&elapsedTimeMs=6&view=print&d%E2%80%A6. Accessed August 18, 2014. 3. Hide M. Urticaria. Therapy of Skin
Diseases: A Worldwide Perspective on Therapeutic Approaches and Their Molecular Basis. Ed. Krieg T, Bickers DR, Miyachi Y. Springer, 2010. 247-62.
Printed in Canada
14XOL073E
Novartis Pharmaceuticals Canada Inc. 2015