Urticaria Control Test (UCT): Definition and Clinical Application
The Urticaria Control Test (UCT) is a validated 4-item patient-reported questionnaire that retrospectively assesses disease control in chronic urticaria over the preceding 4 weeks, with a score ≥12 indicating well-controlled disease and scores <12 requiring treatment escalation. 1
What the UCT Measures
The UCT consists of 4 questions, each with 5 answer options scored from 0 to 4 points, yielding a total score range of 0-16 points 1, 2:
- Question 1: Physical symptom burden (itch, hives, swelling) over the last 4 weeks 1
- Question 2: Quality of life impact from urticaria over the last 4 weeks 1
- Question 3: Frequency of inadequate treatment response over the last 4 weeks 1
- Question 4: Overall disease control over the last 4 weeks 1
Scoring System During Clinical Examination
Answer Options and Point Values
Each question uses the same 5-point scale, though the specific wording varies by question 1:
- 0 points: "Very much" (worst control) or "Very often" (most frequent symptoms)
- 1 point: "Much" or "Often"
- 2 points: "Somewhat" or "Sometimes"
- 3 points: "A little" or "Seldom"
- 4 points: "Not at all" (best control) or "Very well" (best controlled)
Calculating the Total Score
Sum all 4 question responses to obtain the total UCT score (range: 0-16 points). 1, 2
Interpreting Results
- UCT ≥12 points: Well-controlled disease; continue current treatment 1, 3
- UCT <12 points: Poorly controlled disease; escalate treatment according to guideline algorithm 1, 3
Clinical Implementation
When to Use the UCT
Administer the UCT at baseline and every follow-up visit to guide treatment decisions. 1, 3 The UCT should be used for:
- Patients with chronic spontaneous urticaria (CSU) who develop wheals with or without angioedema 1
- Patients with chronic inducible urticaria 1, 2
- Monitoring treatment response and determining need for therapy adjustment 1
Practical Administration
The UCT takes approximately 1-2 minutes to complete and can be self-administered by patients in the waiting room or during the clinical encounter. 2 The retrospective 4-week recall period eliminates the need for prospective daily diaries, making it ideal for routine clinical practice 2.
Integration with Other Assessment Tools
For patients with wheals only, use the UCT alone; for patients with angioedema (with or without wheals), use both the UCT and the Angioedema Control Test (AECT). 1 The AECT has a cutoff of 10 points for well-controlled disease 1.
Validation and Reliability
The UCT demonstrates excellent psychometric properties 2, 4:
- Internal consistency: Cronbach's alpha of 0.89 for CSU patients 4
- Convergent validity: Strong correlation with quality of life measures (r = -0.649 with CU-Q2oL) 4
- Test-retest reliability: Excellent reproducibility 2
- Screening accuracy: High ability to identify patients with insufficiently controlled disease 2
Common Pitfalls and Caveats
Do not confuse the UCT with the 7-Day Urticaria Activity Score (UAS7), which prospectively measures disease activity rather than disease control. 1, 5 The UAS7 requires daily documentation of wheal count and pruritus severity for 7 consecutive days, yielding scores from 0-42 points 1, 5.
The UCT assesses control (how well the disease is managed), while the UAS7 assesses activity (how severe the disease currently is). 3, 5 Both tools serve complementary but distinct purposes in chronic urticaria management.
Ensure patients understand the 4-week recall period when completing the UCT, as this retrospective timeframe is critical for accurate assessment. 2, 4