🌊 Men's Health

Chronic Urticaria (Hives) in Nigeria

Understanding and treating persistent hives and allergic wheals

Urticaria (hives) presents as itchy, red or pale wheals on the skin that come and go. Acute urticaria (lasting less than 6 weeks) is usually triggered by food, drugs, or infection. Chronic urticaria (lasting more than 6 weeks) affects 0.5–1% of Nigerians at some point and is often idiopathic (no identifiable cause). It is more common in women and adults in their 30s–50s. Management is focused on symptom control because a cause is found in fewer than 20% of cases.

Signs and Symptoms

✓ Itchy, raised wheals ranging from a few millimetres to several centimetres

✓ Wheals are transient — appear and disappear within 24 hours, but new ones keep forming

✓ Skin returns to normal between episodes (unlike eczema)

✓ Angioedema: deeper swelling of the lips, tongue, eyelids, or hands in ~40% of cases

✓ Wheals can be red, pink, or pale in the centre with a red flare

✓ Symptoms often worse in the evening and at night, interfering with sleep

Risk Factors

Autoimmune: most chronic urticaria is autoimmune — the body attacks its own mast cells
Infections: H. pylori, hepatitis B/C, parasitic infections common in Nigeria (should be excluded)
NSAIDs and aspirin: worsen urticaria in ~20% of chronic sufferers
Physical triggers: pressure (dermatographism), cold (cold urticaria), heat, exercise, sunlight
Thyroid disease: both hyper and hypothyroidism associated with chronic urticaria
Stress is a common exacerbating factor

When to Seek Help

EmergencySwelling of the tongue, throat, or lips with breathing difficulty or swallowing problems — this is anaphylaxis; call emergency services immediately

UrgentUrticaria with fever, joint pain, or dark urine (may indicate urticarial vasculitis or systemic disease requiring investigation)

RoutineHives lasting more than 6 weeks, waking at night with itching, or significantly affecting quality of life — seek dermatology assessment

Tests & Diagnosis

🧪 FBC and differential

Eosinophilia suggests parasitic infection or drug reaction

🧪 Thyroid function (TSH)

Thyroid disease is an important and treatable cause of chronic urticaria

🧪 H. pylori testing

Breath test, stool antigen, or serology — eradicating H. pylori resolves urticaria in some patients

🧪 Stool microscopy

To exclude intestinal parasites (common in Nigeria) which can trigger urticaria

🧪 Autologous serum skin test (ASST)

Dermatology test to identify autoimmune urticaria — patient's own serum injected into skin; positive reaction = autoimmune subtype

Treatment Options

Modern antihistamines (non-sedating)

Cetirizine, loratadine, or fexofenadine — first-line treatment; doses up to 4× the standard dose may be used under medical supervision for chronic urticaria

Avoid triggers and exacerbators

Stop NSAIDs; avoid alcohol; treat any underlying infection (H. pylori, parasites); reduce stress; avoid tight clothing

Omalizumab (anti-IgE)

Highly effective for antihistamine-resistant chronic urticaria — monthly injection; registered in Nigeria but costly; available in some tertiary hospitals

Short courses of oral steroids

Prednisolone used for severe flares; not suitable for long-term use due to side effects

Treat underlying conditions

Thyroid hormone replacement if hypothyroid; parasite eradication if positive stool test — may resolve urticaria

Cyclosporine

Immunosuppressant used for refractory cases; requires monitoring of blood pressure and kidney function

Frequently Asked Questions

Is chronic urticaria an allergy?

Not always — most chronic urticaria is autoimmune, not allergic. Allergy testing (skin prick tests for food/environmental allergens) is usually not helpful in chronic urticaria.

Will chronic urticaria go away?

50% of cases resolve within 1 year; 20% persist for 5+ years. The autoimmune type tends to last longer but does eventually resolve in most patients.

What foods cause chronic urticaria?

Food allergy causes acute urticaria (immediate reaction within 1–2 hours). In chronic urticaria, specific foods rarely cause chronic disease, though some people react to food additives or naturally-occurring histamines in fermented foods.

Is it safe to take cetirizine daily for months?

Yes — modern non-sedating antihistamines like cetirizine and loratadine are safe for long-term daily use. They do not cause dependence or significant side effects in most people.

Can urticaria affect internal organs?

Urticaria itself only affects skin and subcutaneous tissue. However, urticarial vasculitis and systemic mastocytosis — rarer conditions that can look similar — do affect internal organs and need investigation.