PONE-D-24-32836Factors Associated with Quality of Life of Chronic Spontaneous Urticaria Patients in a Vietnamese PopulationPLOS ONE

Dear Dr. Le,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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ACADEMIC EDITOR: The editorial board and external reviewers have thoroughly evaluated your manuscript. It may be reconsidered if appropriate revisions are made. Specifically, the study methods and data analysis need to be presented more clearly.

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Bharat Bhushan Sharma, M.D.

Academic Editor

PLOS ONE

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Additional Editor Comments:

The editorial board and external reviewers have thoroughly evaluated your manuscript. It may be reconsidered if appropriate revisions are made. Specifically, the study methods and data analysis need to be presented more clearly.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The manuscript entitled 'Factors associated with quality of life of chronic spontaneous urticaria patients in a Vietnamese population' by My et al addressed the question about affecting factors on QOL of Vietnamese people. To do so, they employed cross-sectional study and conducted at the Vietnam National Dermatology and Venereology Hospital by recruiting 358 patients with chronic spontaneous urticaria aged older than 16 years old. Consequently, they found a panel of factors negatively affecting the patients' QSL (as shown in Table 2 and 3). Although this kind of analysis is not unique, we clinician should know the ethnic difference regarding each disease. In this context, it is worth reading in order to know Vietnamese mentality on this chronic pruritic allergic disorder.

Reviewer #2: The authors describe data on chronic spontaneous urticaria in a Vietnamese population. They assess QoL in these patients and correlate QoL responses with different conditions.

Some issues to address:

- Do the authors consider the QoL questionnaire adequate for the Vietnamese setting? Would the authors propose any modifications or an adapted version? They should discuss whether or not the QoL questionnaire is compatible with the Vietnemese population or which modifications could be suggested

- The diagnostic criteria of chronic spontaneous urticaria could be clearer. Did the authors investigate aggravating factors such as NSAIDs? Newly administered drugs or infections were actively excluded?

- The authors mention basopenia and eosinopenia, but there is no mention of eosinophilia in the studied population. Were there eosinophilic patients in the cohort? Were causes of eosinophilia such as atopic or parasitic disease excluded?

- Do the authors have data on systemic symptoms such as fever and arthralgia? These symptoms can be correlated with urticaria and impact patient’s QoL.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-24-32836R1Factors Associated with Quality of Life of Chronic Spontaneous Urticaria Patients in a Vietnamese PopulationPLOS ONE

Dear Dr. Le,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

ACADEMIC EDITOR: After the initial review and the author's subsequent revisions, the journal's requirements necessitated an additional review, which has now been completed. The comments are being forwarded for further amendments. ==============================

Please submit your revised manuscript by Jan 16 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Bharat Bhushan Sharma, M.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

After the initial review and the author's subsequent revisions, the journal's requirements necessitated an additional review, which has now been completed. The comments are being forwarded for further amendments.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: (No Response)

Reviewer #4: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Partly

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #3: No

Reviewer #4: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: As I mentioned to the authors, this manuscript is worth being accepted in PLoS One, based on the face that it's important to know ethnic feelings to the diseases such as urticaria even when similar analyses were already published before.

Reviewer #3: The study is very interesting and will contribute to the understanding of the factors affecting QoL in chronic spontaneous urticaria. It may help in enhancing management strategies involving CSU. The article is carefully written, methodology is robust and the research questions have been adequately addressed. I have provided my comments below.

Abstract:

1. To improve readability, please restructure this part: ‘…in the eyes and lips worsened swelling and overall QoL’.

2. “Longer disease duration increased pruritus scores, while a history of allergy worsened total QoL, sleep, and looks”. Please consider using the words like ‘associated’ or ‘related’ in this context.

Introduction:

3. Please provide a recent reference supporting the estimated point prevalence of CSU. (Line 4; …estimated point prevalence of around 0.5% to 1%.)

4. Please maintain consistency in using abbreviated form. For example, CSU or CU. (Line 18; … for CU patients has been..)

Materials and Method:

5. Please keep either the words ‘CSU patients’ or ‘with CSU’ in the sentence ‘A cross-sectional, single-center study involving CSU patients aged 16 years or older with CSU was conducted at the Urticaria Clinic at the Vietnam National Dermatology and Venereology Hospital from 1 June 2023 to 31 March 2024.’

6. How the severity of itching (mild/ moderate/ severe) was assessed? Did you use any scale? You have also evaluated pruritus (2 items) as a part of CU-Q2oL tool. Was it done differently?

Results:

7. Though mentioned 358, the sum of n in table 2 in actually 357. If there was a missing value, please mention.

8. ‘The “≤Mild (0-15)”, “Moderate (16-27)” and “Severe (28-42)” groups had…’. It looks like that, you actually combined ‘very mild’ and ‘mild’ together and considered those as ‘mild’. This may be acceptable, because ‘very mild’ group had only 3 participants. In addition, some in ‘very mild’ UAS7 category might also be assessed as ‘mild’ category. Please add a sentence in the method section addressing this issue about combining those two.

Conclusion:

9. You may consider replacing the word ‘importance’ with the word ‘necessity’ in the sentence, “The findings underscore the importance of comprehensive and culturally appropriate management strategies to address CSU's physical and psychological impacts.”

Reviewer #4: In the manuscript, the authors explored the quality of life (QoL) among patients with chronic spontaneous urticaria (CSU) in Vietnam and identified factors associated with QoL. This cross-sectional study recruited 358 patients aged 16 years or older at the Vietnam National Dermatology and Venereology Hospital between June 2023 and March 2024. Using the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) and the Weekly Urticaria Activity Score (UAS7), the study assessed QoL and disease severity. The findings revealed significant impairment in QoL across physical, emotional, and social domains, with factors such as higher UAS7 scores, angioedema in the eyes and lips, longer disease duration, and a history of allergy being associated with poorer QoL outcomes. These findings emphasize the importance of integrating regular QoL assessments into CSU management to support patient-centered care strategies.

The authors have appropriately responded to the reviewers' comments, enhancing the clarity and rigor of their findings. However, this study is a retrospective, single-center observational analysis, necessitating careful attention to comparative analyses of the data. In particular, comparisons among UAS7 mild, UAS7 moderate, and UAS7 severe groups require meticulous consideration. While Table 1 provides baseline characteristics, it would be beneficial to stratify these into the three UAS7 severity groups and assess for any statistically significant differences. Even if no statistically significant differences are identified, any apparent variation between groups warrants additional discussion regarding the potential for confounding bias. This further analysis would strengthen the study's validity and ensure comprehensive interpretation of the findings.

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Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #3: Yes: Ruhul Amin

Reviewer #4: No

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Factors Associated with Quality of Life of Chronic Spontaneous Urticaria Patients in a Vietnamese Population

PONE-D-24-32836R2

Dear Dr. Le,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Bharat Bhushan Sharma, M.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The peer review of the paper has been completed, and it is now suitable for publication in the journal.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: All comments have been addressed

Reviewer #4: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Yes

Reviewer #4: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: Yes

Reviewer #4: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: No

Reviewer #4: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

Reviewer #4: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: Thank you for addressing the comments. This is an interesting study and after improving, the manuscript looks better.

Reviewer #4: The authors have appropriately responded to the reviewers' comments, including the potential selection bias of three UAS7 severity groups.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #3: Yes: Ruhul Amin

Reviewer #4: No

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