Automatic screening of self‐evaluation apps for urticaria and angioedema shows a high unmet need
Authors: Aram Antó, Rasmus Maurer, Ana Gimenez‐Arnau, Ivan Cherrez‐Ojeda, Tomasz Hawro, Markus Magerl, Martin Metz, Karsten Weller, Torsten Zuberbier, Jean Bousquet, Marcus Maurer
Journal: Allergy (2021)

In chronic urticaria (CU) and recurrent angioedema (RAE), the need for effective treatment is high. The goals are for patients to have no signs and symptoms, normal quality of life (QoL), and complete disease control. Disease activity is assessed using scores such as the urticaria and the angioedema activity scores, that is, patient-reported outcome measures (PROMs) that rely on the daily documentation, by patients, of wheals and itch and of angioedema, respectively. This is complemented by the regular assessment of QoL and disease control with suitable PROMs, for example, the urticaria control test (UCT) or the angioedema control test (AECT).1 Apps are ideally suited for documentation of the patients' daily signs and symptoms and regular assessments of their QoL and disease control. Apps can also help to identify relevant triggers (eg, stress and infections), consequences (eg, sleep impairment, missing work, or school), and comorbidities, a major need in CU and RAE. Moreover, apps can optimize treatment by individualizing therapy in order to reach goals. However, the availability and functionality of apps for the self-evaluation of CU and RAE are unknown. To address this knowledge gap, we developed and applied an automatic search algorithm for self-evaluation apps for CU and RAE in Apple App and Google Play stores. We used the methods that we had previously applied to asthma and anaphylaxis.2 The search was performed in July 2021 (Figure 1). Briefly, we first designed the search algorithm to include seven search terms, each in three languages, that is, English, German, and Spanish (Table S1), then used the algorithm to search the app stores in 16 countries (Table S2), and finally assessed the apps identified for eligibility, that is, helping patients to track their signs and symptoms and manage their disease, by integrating information on triggers, consequences, comorbidities, and/or treatment. Our manual search, performed in parallel, used the same search terms, app stores, languages, countries, and eligibility criteria (Table 1). The apps were then assessed for their availability, functions, and features. N = 22a a routine dental cleaning, other dental procedure, medical procedure, minor injury or prolonged physical pressure, infection/illness, taking birth control, menstrual period, menopause, being pregnant, fatigue, being on hormone replacement therapy, food or non-alcoholic beverages, stress, anger/frustration, lack of sleep, medication, alcohol, sadness/depression, constipation, anxiety, weather Others (can be entered) Impact of attack School/work days missed N = 7b b androgens, antifibrinolytics, C1-inhibitor intravenously; C1-Inhibitor subcutaneously, progesterone, clinical study drug (can be typed in), lanadelumab regular N = 16c c berinert, cinryze, ruconest, heagarda, kalbitor, firazyr, corticosteroids, antihistamines, clinical trial study drug (can be typed in), narcotic pain medicine, non-narcotic pain medicine, intravenous fluids, additional androgens, additional antifibrinolytics, fresh frozen plasma, epinephrine on demand Others (can be entered) N = 9d d stress, trauma, surgical procedures, contraceptives, angiotensin converting enzyme inhibitors, dental work, viral infections, hormone replacement therapy, unknown Others (can be entered) N = 6f f infection, stress, medical or dental procedure, trauma, flue-like symptoms, unknown Others (can be entered) HAE & Me N = 8g g anxiety, stress, minor injury, dental/medical/surgical procedure, fatigue, certain medications, infection, hormonal changes Others (can be entered) N = 9i i scratching, cold, sun, pressure, exercise, heat, alcohol, allergies, unknown. Others (can be entered) Our automatic and manual searches both identified the same nine apps for CU and/or RAE self-evaluation (Table 1): (a) four for hereditary angioedema (HAE), that is, Advance HAE, HAERO, myHAE, and HAE & me, none of which allow for tracking of wheals or itch, and (b) five for CU, that is, TARGET My Hives, UrCare, UrticariApp, and SymTrac™ HIVES (Table 1). All apps can be used to document signs and symptoms, an inclusion criterion of our search. Of the nine apps, six allowed for the documentation of triggers, three for PROM-based disease-driven impact, six for treatment, and one for disease control. Only one app was available in more than two languages, and none covered comorbidities or provided individualized advice (Table 1). Our findings demonstrate that currently available iOS/Android apps for the self-evaluation of CU and RAE are very limited in number, function, and geographical reach, and that none cover comorbidities. Use of the same approach in asthma and anaphylaxis showed very similar results. The results of the UCARE CURICT study demonstrated that most CU patients, especially those with higher education and in rural areas, are interested in the use of digital tools for their health care.3, 4 Clearly, better apps are needed and wanted. Taken together, we identified a major unmet need in CU and RAE: that of the lack of suitable apps for patients to (a) self-evaluate their disease activity, impact, and control, (b) improve the self-management of their condition by recognizing important triggers of exacerbation, comorbidities, and consequences of their disease, and (c) optimize their therapy including allergic comorbidities. Novel apps that allow patients to do this are needed globally. Such apps are expected to improve the management of CU and RAE and may also serve as important tools for CU and RAE research. Dr. Antó has nothing to disclose. Rasmus Maurer has nothing to disclose. Dr. Gimenez-Arnau reports grants and personal fees from Uriach Pharma, grants, personal fees and other from NOVARTIS PHARMA, personal fees from SANOFI - REGENERON, personal fees from AMGEN, grants and personal fees from GSK, personal fees from THERMO FISHER, personal fees from ALMIRALL, grants from CARLOS III FEWDER, personal fees from AVENE, personal fees and other from LEO, outside the submitted work. Dr. Cherrez-Ojeda reports grants from Universidad Espiritu Santo, personal fees from Sanofi, outside the submitted work. Dr. Hawro has nothing to disclose. Dr. Magerl reports personal fees and non-financial support from Shire / Takeda, personal fees and non-financial support from CSL Behring, personal fees from Pharming, personal fees and non-financial support from Biocryst, personal fees from Kalvista, personal fees from Octapharma, personal fees from Novartis, outside the submitted work. Dr. Metz reports personal fees from Novartis, personal fees from Sanofi, personal fees from Celldex, personal fees from Moxie, personal fees from Pharvaris, outside the submitted work. Dr. Weller reports personal fees from Biocryst, personal fees from Moxie, grants and personal fees from Novartis, grants and personal fees from Takeda, outside the submitted work. Dr. Zuberbier reports personal fees from Bayer Health Care, personal fees from FAES, grants and personal fees from Novartis, grants and personal fees from Henkel, personal fees from AstraZeneca, personal fees from AbbVie, personal fees from ALK, personal fees from Almirall, personal fees from Astellas, personal fees from Bayer Health Care, personal fees from Bencard, personal fees from Berlin Chemie, personal fees from FAES, personal fees from HAL, personal fees from Leti, personal fees from Meda, personal fees from Menarini, personal fees from Merck, personal fees from MSD, personal fees from Novartis, personal fees from Pfizer, personal fees from Sanofi, personal fees from Stallergenes, personal fees from Takeda, personal fees from Teva, personal fees from UCB, personal fees from Henkel, personal fees from Kryolan, personal fees from L'Oréal, outside the submitted work; and Organizational affiliations: Commitee member: WHO-Initiative "Allergic Rhinitis and Its Impact on Asthma" (ARIA) Member of the Board: German Society for Allergy and Clinical Immunology (DGAKI) Head: European Centre for Allergy Research Foundation (ECARF) President: Global Allergy and Asthma European Network (GA2LEN) Member: Committee on Allergy Diagnosis and Molecular Allergology, World Allergy Organization (WAO). Dr. Bousquet reports personal fees from Chiesi, Cipla, Hikma, Menarini, Mundipharma, Mylan, Novartis, Sanofi-Aventis, Takeda, Teva, Uriach, other from KYomed, MASK-air, outside the submitted work. Dr. Maurer reports grants and personal fees from Allakos, personal fees from Aralez, grants from ArgenX, grants from AstraZeneca, personal fees from Celldex, grants and personal fees from CSL Behring, grants and personal fees from FAES, grants and personal fees from Genentech, grants from Innate Pharma, personal fees from Kalvista, grants and personal fees from Kyowa Kirin, grants from Leo Pharma, grants from Lilly, grants and personal fees from Menarini, grants and personal fees from Moxie, grants and personal fees from Novartis, grants from Roche, grants and personal fees from Sanofi/Regeneron, grants and personal fees from Shire/Takeda, grants and personal fees from UCB, grants and personal fees from Uriach, outside the submitted work. 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