UAS7 + DLQI for patient use
The Urticaria Activity Symptom 7 (UAS7) score sheet and the Dermatology Life Quality Index (DLQI) are a standardised patient-reported questionnaires which are used to measure the severity of ongoing chronic spontaneous urticaria. The UAS7 measures 2 outcomes: the quantity of hives and the severity of the pruritus (itching). The totals are calculated from daily scores over 1 week.
These scores are recorded on patient’s medical file and can be used as criteria within multi team disciplinary meetings for treatment of chronic spontaneous urticaria.
Urticaria Activity Symptom 7 Day Score Sheet (UAS7)
Please complete the diary for 7 days. This will provide your UAS7 score for the week before your next appointment or review. When completing the diary, please try to consider the previous 24 hours as a whole, not merely the current situation.
Step 1: Instructions
Evaluate the last 24 hours in terms of both the wheals (hives) and the itching with a score, using the scale detailed in the table below:
| Score | Wheals (hives) | Itching |
|---|---|---|
| 0 | No wheals | None |
| 1 | Mild (<20 wheals) |
Mild (present but not annoying or troublesome) |
| 2 |
Moderate (20-50 wheals) |
Moderate (troublesome but does not interfere with normal daily activity or sleep) |
| 3 |
Intense (>50 wheals) |
Intense (severe itch, which is sufficiently troublesome to interfere with normal daily activity or sleep) |
Step 2: Your weekly scores
Please enter your scores for the corresponding day in the table below by circling the appropriate number. Add the two scores together and write the total for that day in the right hand column. Finally, at the end of the week, add the seven daily scores and enter your UAS7 score in the weekly total box.
| Patient name: | Hospital or NHS number: | Date of completion: |
|---|---|---|
| Patient name: | Hospital or NHS number: | Date of completion: |
| Patient name: | Hospital or NHS number: | Date of completion: |
| Day | Date | None | Mild | Moderate | Intense | None | Mild | Moderate | Intense | Total |
|---|---|---|---|---|---|---|---|---|---|---|
| Day 1 | Date | None 0 | Mild 1 | Moderate 2 | Intense 3 | None 0 | Mild 1 | Moderate 2 | Intense 3 | Total |
| Day 2 | Date | None 0 | Mild 1 | Moderate 2 | Intense 3 | None 0 | Mild 1 | Moderate 2 | Intense 3 | Total |
| Day 3 | Date | None 0 | Mild 1 | Moderate 2 | Intense 3 | None 0 | Mild 1 | Moderate 2 | Intense 3 | Total |
| Day 4 | Date | None 0 | Mild 1 | Moderate 2 | Intense 3 | None 0 | Mild 1 | Moderate 2 | Intense 3 | Total |
| Day 5 | Date | None 0 | Mild 1 | Moderate 2 | Intense 3 | None 0 | Mild 1 | Moderate 2 | Intense 3 | Total |
| Day 6 | Date | None 0 | Mild 1 | Moderate 2 | Intense 3 | None 0 | Mild 1 | Moderate 2 | Intense 3 | Total |
| Day 7 | Date | None 0 | Mild 1 | Moderate 2 | Intense 3 | None 0 | Mild 1 | Moderate 2 | Intense 3 | Total |
| Day | Date | None | Mild | Moderate | Intense | None | Mild | Moderate | Intense |
Total
Weekly total: |
Thank you for taking the time to complete this form carefully. Please either bring to your next appointment or email to the Allergy Secretaries, along with your hospital number.
Dermatology Life Quality Index (DLQI)
| Patient name: | Hospital or NHS number: | Date of completion: |
|---|---|---|
| Patient name: | Hospital or NHS number: | Date of completion: |
| Patient name: | Hospital or NHS number: | Date of completion: |
The aim of this questionnaire is to measure how much your skin problem has affected your life over the last seven days. Please tick one box for each question.
Patient Name:
|
Select one box per question |
Very much | A lot | A Little | Not at all | Not relevant | |
|---|---|---|---|---|---|---|
| 1 |
Select one box per question Over the last 7 days, how itchy, sore, painful or stinging has your skin been? |
Very much | A lot | A Little | Not at all | Not relevant |
| 2 |
Select one box per question Over the last 7 days, how embarrassed or self-conscious have you have because of your skin? |
Very much | A lot | A Little | Not at all | Not relevant |
| 3 |
Select one box per question Over the last 7 days, how much has your skin interfered with you going shopping or looking after your home or garden? |
Very much | A lot | A Little | Not at all | Not relevant |
| 4 |
Select one box per question Over the last 7 days, how much has your skin influenced the clothes you wear? |
Very much | A lot | A Little | Not at all | Not relevant |
| 5 |
Select one box per question Over the last 7 days, how much has your skin affected any social or leisure activities? |
Very much | A lot | A Little | Not at all | Not relevant |
| 6 |
Select one box per question Over the last 7 days, how much has your skin made it difficult for you to do any sport? |
Very much | A lot | A Little | Not at all | Not relevant |
| 7 |
Select one box per question Over the last 7 days, has your skin prevented you from working or studying? If ‘No’, over the last 7 days how much has your skin been a problem at work or studying? |
Very much | A lot | A Little | Not at all | Not relevant |
| 8 |
Select one box per question Over the last 7 days, how much has your skin created problems with your partner or any of your close friends or relatives? |
Very much | A lot | A Little | Not at all | Not relevant |
| 9 |
Select one box per question Over the last 7 days, how much has your skin caused any sexual difficulties? |
Very much | A lot | A Little | Not at all | Not relevant |
| 10 |
Select one box per question Over the last 7 days, how much of a problem has the treatment for your skin been, for example by making your home messy, or by taking up time? |
Very much | A lot | A Little | Not at all | Not relevant |
| 10 |
Select one box per question Over the last 7 days, how much of a problem has the treatment for your skin been, for example by making your home messy, or by taking up time? |
Very much | A lot | A Little | Not at all | Not relevant |
Thank you for taking the time to complete this form carefully. Please either bring to your next appointment or email to
MyChart
We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device
More information is available on our website: MyChart
Contacts/further information
Allergy secretaries: 01223 217 777
References/sources of evidence
Urticaria Activity Score 7 or ‘UAS7’ (Mathias et al 2012)
(NICE, 2015)
BSACI 2015 John Wiley & Sons Ltd
We are smoke-free
Smoking is not allowed anywhere on the hospital campus. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.
Other formats
Help accessing this information in other formats is available. To find out more about the services we provide, please visit our patient information help page (see link below) or telephone 01223 256998. www.cuh.nhs.uk/contact-us/accessible-information/
Contact us
Cambridge University Hospitals
NHS Foundation Trust
Hills Road, Cambridge
CB2 0QQ
Telephone +44 (0)1223 245151
https://www.cuh.nhs.uk/contact-us/contact-enquiries/