30-Year Analysis of Chronic Urticaria in the MENA Region Reveals Decades of High Burden

According to a new systematic analysis of Global Burden of Disease (GBD) 2021 data, the burden of urticaria in the Middle East and North Africa (MENA) region remained largely unchanged from 1990 to 2021, although substantial differences were observed by country, age, sex, and socioeconomic development.¹

In 2019, a total of 65 million patients were affected by urticaria, with a disability-adjusted life years (DALYs) rate of 50.4 per 100,000 people.² Although previous studies have focused on the global and regional burden of urticaria, none have primarily focused on MENA regions. The current research evaluated incidence, prevalence, and DALYs associated with urticaria across 21 MENA countries. Estimates were generated using the DisMod-MR 2.1 Bayesian meta-regression tool and reported as total counts and age-standardized rates per 100,000 individuals, with 95% uncertainty intervals.

Regional Burden and Geographic Disparities

In 2021, the region recorded an estimated 10.3 million incident cases and 5.9 million prevalent cases of urticaria. The age-standardized incidence rate (ASIR) was 1649.2 per 100,000 (95% UI, 1452.7-1854.3), while the age-standardized point prevalence was 936.1 per 100,000 (95% UI, 825.8-1058.6). The age-standardized DALY rate was 56.1 per 100,000 (95% UI, 36.8-79.2), representing more than 353,000 DALYs. None of these measures showed a significant change between 1990 and 2021.

Egypt had the highest age-standardized incidence, prevalence, and DALY rates in the region. Its ASIR was 1892.4 per 100,000, compared with 1503.2 per 100,000 in Turkey, which had the lowest rate. Egypt also had the highest age-standardized prevalence rate at 1084.3 per 100,000 and the highest DALY rate at 65.2 per 100,000. Iran had the second-highest incidence and prevalence rates and the second-highest DALY rate. Turkey had the lowest rates across the 3 measures.

Socioeconomic and Demographic Differences

Sex-based differences were also identified. Females generally had higher incidence, prevalence, and DALY rates than males across the region. Incidence rates were consistently higher among females across age groups, although the number of incident cases among men became slightly higher after age 65. Female DALY rates were higher at all ages, while total DALYs among men exceeded those among women in age groups older than 55 years.

Age was another important factor in the distribution of disease burden. Incident cases and rates were highest among children younger than 5 years in both sexes. Incidence and prevalence decreased sharply through the 10- to 15-year age group before remaining relatively stable through approximately age 70 to 75, followed by a decline among older age groups. DALYs showed a similar pattern, with the highest burden among children younger than 5 years.

MORE ON CHRONIC SPONTANEOUS URTICARIA

The analysis also found an inverse V-shaped relationship between age-standardized DALY rates and socioeconomic development. DALY rates increased with the socio-demographic index (SDI) up to approximately 0.5 before declining at higher SDI levels. Countries with mid-level SDI had the highest burden. Turkey had a lower burden than expected based on its SDI, whereas Iran and Egypt had higher-than-expected burdens.

Limitations and Future Recommendations

The authors noted several limitations, including sparse data and potential underreporting in the MENA region. The GBD dataset also does not distinguish among different forms of urticaria, including chronic spontaneous and inducible subtypes, limiting the ability to assess subtype-specific patterns. Differences in health care systems, disease definitions, and reporting practices may also contribute to inconsistencies between countries.

Overall, the findings indicate that urticaria continues to represent a substantial health burden in the MENA region, with little change over more than 3 decades. The authors recommended standardized reporting, better public health interventions, greater awareness, improved policies and access to health care resources, and efforts to reduce exposure to environmental factors such as pollutants and allergens.

References

1. Bagheryan AS, Oraee S, Fekri M, et al. The Burden of Urticaria in the Middle East and North Africa Region From 1990 to 2021: A Systematic Analysis Based on the GBD Study 2021. Health Sci Rep. 2026;9(8):e72976. Published 2026 Aug 4. doi:10.1002/hsr2.72976

2. Liu X, Cao Y, Wang W. Burden of and Trends in Urticaria Globally, Regionally, and Nationally from 1990 to 2019: Systematic Analysis. JMIR Public Health Surveill. 2023;9:e50114. Published 2023 Oct 26. doi:10.2196/50114