Urticaria Activity Score (UAS7)
7-day urticaria activity score assessing wheals and pruritus, used to guide antihistamine dosing and omalizumab eligibility in chronic spontaneous urticaria (CSU).
Score interpretation
UAS7 0: itch- and hive-free (complete response).
→ Maintain or step-down treatment. If on standard-dose antihistamine: consider reducing to PRN. If on omalizumab: discuss dose spacing. Trigger identification and avoidance. Allergy review if food/drug triggers suspected.
UAS7 1–6: well-controlled urticaria.
→ Maintain or step-down treatment. If on standard-dose antihistamine: consider reducing to PRN. If on omalizumab: discuss dose spacing. Trigger identification and avoidance. Allergy review if food/drug triggers suspected.
UAS7 7–15: mild chronic spontaneous urticaria activity.
→ Adults: Non-sedating antihistamine (cetirizine 10mg or loratadine 10mg) OD. If inadequate response after 2–4 weeks: up-dose to 4× licensed dose (off-label but EAACI-endorsed). Children: use a children's formulary. Avoid triggers. BSACI/EAACI guideline.
UAS7 16–27: moderate activity.
→ Adults: Non-sedating antihistamine (cetirizine 10mg or loratadine 10mg) OD. If inadequate response after 2–4 weeks: up-dose to 4× licensed dose (off-label but EAACI-endorsed). Short course prednisolone (0.5 mg/kg × 5–7 days) for acute exacerbations. Children: use a children's formulary. If still uncontrolled: specialist dermatology/immunology referral (NICE TA339 omalizumab needs UAS7 ≥ 28). Avoid triggers.
UAS7 28–42: severe activity.
→ Adults: Omalizumab 300mg SC every 4 weeks — NICE TA339 (age 12 and over): add-on for severe CSU (e.g. UAS7 ≥ 28) not responding to H1-antihistamines and leukotriene receptor antagonists; stop at or before the 4th dose if no response, and at the end of a 6-dose course if it responds. Short course prednisolone (0.5 mg/kg × 5–7 days) for acute exacerbations. Children: use a children's formulary. Specialist dermatology/immunology referral.
Interpretation bands for the UAS7. Apply clinical judgement and local guidance.
References
- Zuberbier T et al. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2022.
- Stull D, McBride D, Tian H, et al. Analysis of disease activity categories in chronic spontaneous/idiopathic urticaria. Br J Dermatol. 2017;177(4):1093–1101.
- NICE TA339. Omalizumab for treating chronic spontaneous urticaria. 2015.
Related
Curated clinical cross-links plus same-class fallbacks.
- Omalizumab (Dermatology — Chronic Urticaria) · Anti-IgE Monoclonal Antibody
- Promethazine · First-Generation Antihistamine — Burns Pruritus / Sedation
- Pindolol · Non-selective β-blocker (with intrinsic sympathomimetic activity)
- Cyproheptadine · Antidote / Antihistamine
- Cetirizine hydrochloride · Non-sedating H1 antihistamine
- Chlorphenamine maleate · Sedating H1 antihistamine
- Suspicious Pigmented Lesion — Melanoma Pathway · NICE NG14 2015 / BAD
- Cellulitis and Erysipelas · NICE NG141 2019 / CREST
- Psoriasis — Severity Assessment and Step-Up Therapy · NICE NG153 2019 / BAD
- Atopic Eczema — Assessment and Step-Up Therapy · NICE NG95 2023
- Urticaria and Angioedema · BSACI / EAACI Guidelines 2022
- Acne Vulgaris — Grading and Treatment · NICE NG198 2021 / BAD
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.