Feasibility and Patient Experiences in a <scp>WhatsApp</scp> ‐Based Educational Pilot for Spanish‐Speaking Adults With Chronic Spontaneous Urticaria

Chronic spontaneous urticaria (CSU) is a debilitating condition characterized by recurrent hives and pruritus for more than 6 weeks without an identifiable trigger. It affects up to 1% of people worldwide [1] and imposes substantial quality of life impairment and healthcare costs [2]. Despite evidence-based international guidelines and the availability of targeted biologic therapy such as omalizumab [3], many patients, particularly Spanish-speaking individuals in Latin America, face structural, geographic, and economic barriers to receiving appropriate management [4]. Digital patient communities have become important sources of information and support [5], yet formal digital education models for CSU are underexplored. This exploratory pilot evaluated the feasibility of a WhatsApp-based (Meta Platforms Inc., Menlo Park, CA) educational experience, described baseline knowledge, and characterized patient narratives among Spanish-speaking adults with clinician-diagnosed CSU. The University of Miami Institutional Review Board (IRB) approved the study. Due to limited postintervention survey completion, analysis focused on descriptive baseline data and qualitative themes derived from chat transcripts. Out of thirty adults who registered for the program and received a link to join, seven participated in a moderated 3-day WhatsApp group and received brief Spanish-language modules covering CSU pathophysiology, triggers, and evidence-based management. Participants were encouraged to respond to prompts and discuss their experiences. A 15-item true/false knowledge assessment was completed at enrollment. Qualitative content analysis of chat messages was performed independently by two reviewers using an inductive approach to identify themes. Discrepancies were resolved by consensus. Quotes were translated with verification for accuracy. Participants were predominantly women aged 30–49 years and represented Uruguay, Spain, Argentina, Cuba, Colombia, and Chile (Table 1). None had previously participated in a CSU educational program. Nevertheless, baseline knowledge was uniformly high: four scored 100%, and all scored ≥ 80%. Many attributed their knowledge to years of living with CSU, online self-education, and peer support communities, suggesting a ceiling effect that limited the usefulness of traditional pre/post knowledge testing. Qualitative themes (Figure 1) revealed a substantial and persistent burden of disease. Participants described intense pruritus, urticarial flares, angioedema, and functional impairment. Several reported long-term systemic corticosteroid use, recurrent emergency visits, and minimal benefit from antihistamines. Identified triggers included heat, pressure, stress, temperature changes, non-steroidal anti-inflammatory drugs (NSAIDs), infections, and menstrual cycles. A major cross-cutting theme was restricted access to biologic therapy. Participants from Cuba, Uruguay, Colombia, and Argentina described omalizumab as “not available,” “impossible to access,” or financially unattainable. Those who eventually received omalizumab reported dramatic improvement. Participants also reported encountering clinicians unfamiliar with CSU guidelines, diagnostic criteria, or stepwise management. Some were told their symptoms were due to “stress” or “allergies,” resulting in delayed treatment and heavy reliance on peer communities for validation and support. Despite the modest sample size, consistent patterns emerged across participants: high disease burden, corticosteroid dependence, poor access to biologics, and striking gaps in clinician knowledge. These issues are documented in Latin America but rarely described from the patient perspective [2, 4]. The uniformly high baseline knowledge highlights the sophistication of digitally engaged CSU communities and suggests diminishing returns for standalone patient-facing educational modules in these settings. This pilot demonstrates that WhatsApp-based engagement is feasible, low-cost, and acceptable for Spanish-speaking adults with CSU. However, the intervention's impact on knowledge cannot be assessed due to limited post-survey completion and high baseline literacy. Future studies will pivot from standalone patient-facing education toward hybrid models that integrate provider-facing guideline education. Planned modifications include brief educational modules for frontline clinicians and alternative follow-up strategies to reduce attrition. Such approaches may better address diagnostic delays, inappropriate corticosteroid reliance, and disparities in CSU care across Latin America. We thank Ana María Giménez-Arnau, MD, PhD; Rodrigo Valdes-Rodríguez, MD; and the Urticaria Centers of Reference and Excellence (UCARE) Network for their valuable guidance and expert input. The authors have nothing to report. Ms. Elise Edwards, Mr. Carlos Lange Nava, Ms. Jemima Constanza, Dr. Alison Tran, and Dr. William Abramovits have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Dr. Gil Yosipovitch serves as an advisory board member for Abbvie, Amgen, Arcutis, BI, Celldex, GSK, Escient Health, Eli Lilly, Galderma, Kiniksa Pharmaceuticals, LEO Pharma, Novartis, Merck, Pfizer, Pierre Fabre, Regeneron Pharmaceuticals Inc., Sanofi, and Vifor; Dr. Gil Yosipovitch receives grants/research funding from Eli Lilly, Pfizer, Abbvie, Novartis, Galderma, Escient, Sanofi, Regeneron, and Celldex. The data that support the findings of this study are available from the corresponding author upon reasonable request.