Urticaria control test

Patient name:				Date (dd/mm/yyyy): _____ /_____ /_____
Date of birth (dd/mm/yyyy): _____ /_____ /_____
Instructions: You have urticaria. The following questions should help us understand your current health situation. Please read through each question carefully and choose an answer from the five options that best fits your situation. Please limit yourself to the last four weeks. Please do not think about the questions for a long time, and do remember to answer all questions and to provide only one answer to each question.
	0 points	1 point	2 points	3 points	4 points	Scoring
How much have you suffered from the physical symptoms of urticaria (itch, hives [welts], and/or swelling) in the last four weeks?	Very much	Much	Somewhat	A little	Not at all
How much was your quality of life affected by the urticaria in the last four weeks?	Very much	Much	Somewhat	A little	Not at all
How often was the treatment for your urticaria in the last four weeks not enough to control your urticaria symptoms?	Very often	Often	Sometimes	Seldom	Not at all
Overall, how well has your urticaria been under control in the last four weeks?	Not at all	A little	Somewhat	Well	Very well
					Total points:

Original figure modified for this publication. From: Weller K, Groffik A, Church MK, et al. Development and validation of the Urticaria Control Test: A patient-reported outcome instrument for assessing urticaria control. J Allergy Clin Immunol 2014; 133:1365. Illustration used with the permission of Elsevier Inc. All rights reserved.

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Urticaria control test