How to Resolve Chronic Hives – Audience Question

Today I answer an audience question regarding hives, aka urticaria.  We’ll discuss what causes urticaria and how it can be treated both naturally and with medications. There is a gut and autoimmune component to urticaria, and the treatments are applicable to many other gut and autoimmune conditions.

Dr. R’s Fast Facts

Urticaria, also known as hives

What causes it?

  • There are a few theories as to the cause; autoimmune might be the best supported theory out there
  • Is there a gut connection?
    • Yes, some studies have found gut imbalances, like Blastocystis hominis, to be present

Treatments

 One of our patient stories

https://drruscio.com/autoimmunity-swelling-hives-insomnia-fatigue-relieved-treating-viral-infection-high-iron-levels/

Deep dive into the histamine component

https://drruscio.com/mast-cell-activation-syndrome-clinician-researcher-dr-lawrence-afrin/

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How to Resolve Chronic Hives – Audience Question

Dr. Michael Ruscio: Hi, this is Dr. Ruscio, and let’s discuss an audience question about urticaria or hives. And let me read this question here from Maria.

“Hi, doctor. There is one topic that I’ve never heard any functional doctors talk about, and that is chronic urticaria. There is very little known about what causes this condition and how to treat it effectively. Thanks.”

Sure. So, urticaria, also known as hives. There are different types of urticaria. There are different causes of urticaria. I would like to provide you with a few broad strokes in terms of simple and foundational things that I have found to be helpful.

So again, urticaria/hives and some people will experience hives randomly, some will experience hives from activity, from stress, from hot or cold exposure, from eating certain foods. And these all have different levels of heat-induced, cold-induced urticaria, contact urticaria, what have you. And when we boil it all down, let’s talk about what may be one of the predominant fundamental causes of urticaria and then what you can do about it.

Now, again, there are many theories as to the cause of urticaria. But I think the one that holds the most promise and the most potential is the autoimmune component, meaning that urticaria might be autoimmune or it might be associated with the immune system and/or other autoimmune conditions.

So this is why we may see an increase of urticaria potentially in patients that have hypothyroidism. Luckily though, speculation aside, what’s nice about the autoimmune theory is that it gives us a lot to potentially work with or to modulate. And so, there’s two different angles that we can come at this through. One would be conventional medicine and one would be more integrated medicine. From the integrated perspective, there is definitely some promise in gut-directed therapies because—and probably no surprise—that the gut has a fairly sizable impact on the immune system. Now, this is likely why at least one study that I know of has found a higher prevalence of certain, using the term loosely, infections in the intestines associated with urticaria. And more importantly, treatment of those infections was shown to reduce the severity and duration of urticaria outbreaks.

One study in particular looked at various types of infections. And again, I use that term loosely because not all these things are technically infections. But Blastocystis hominis was the one found to be the most prevalent. Now, Blastocystis hominis is not considered an infection or a strict pathogen. Some circles consider it benign. Some circles consider it pathogenic. And I think the most reasonable approach is if you find Blastocystis hominis in someone with symptoms treat that. So, we have some at least preliminary evidence showing the association and the causal link by treatment that Blastocystis hominis and potentially other gut imbalances may be involved with urticaria and may allow alleviation of urticaria. So, that is very good news.

Now, there are other things that you can do, which would be dietary changes. Dietary changes that help to improve gut health would also stand to reason to be able to benefit. And I think there’s a decent amount of anecdotal evidence to support this. So something like a Paleo diet or standard elimination diet, where you cut out foods that are oftentimes problematic for people, seems to be a reasonable recommendation to make. There also maybe aid garnered through the low FODMAP diet. And the low FODMAP diet kind of transitions us into the topic of how more conventional medicine comes at this, which is with histamine blocking agents, H1 or H2, histamine1, histamine2 antagonists, to try to block histamine, which is part of the immune response, and more so part of the allergy response, using that term loosely.

And remember that allergy and autoimmunity share this fundamental underpinning of the immune system status, so either being a well-calibrated immune system or potentially an overzealous or mal-calibrated immune system.

So conventional medicine typically administers various types of H1, H2 histamine antagonists, histamine blockers, and those can be effective. However, the low FODMAP diet has been shown to cause an eight-fold reduction in histamine according to one study. So a low FODMAP diet may do the same thing as these drugs. And given, they’re over-the-counter drugs and fairly benign, but it may achieve this from a dietary perspective.

Now, there’s also the low histamine diet specifically, which could also be helpful, which reduces dietary histamine. The low FODMAP diet deprives foods that feed bacteria that likely produce histamine and a low histamine diet reduces the amount of actual histamine in the food. So someone can even go as far as to go on a low FODMAP and low histamine diet if they really wanted to go at this aggressively.

Now, also treating any other gut infections could be helpful. Some of these histamine blockers could be helpful. But all that together, if you improve your diet, either an elimination diet, like a Paleo diet or a low FODMAP or low histamine diet, in addition to addressing any imbalances in the gut, and this may be achieved by taking a probiotic. I don’t know of any evidence showing that probiotics help with urticaria. And it may be there and I’m just not aware of it. But it would certainly stand to reason that a treatment of imbalances in the gut can improve urticaria. And if probiotics help to improve the health of the gut, then a probiotic may help with urticaria, but it’s speculative.

But by going through all these steps to optimize your diet, optimize your gut health, I think you have a fairly good probability of coming out with a good response to the urticaria. Now, I’ll also share in the post here, one of our patients who had good results with urticaria, and then also, if you wanted to get really deep into this immune histamine angle, an interview with Dr. Lawrence Afrin, who is a researcher essentially in histamine intolerance, or as it’s also termed mast cell activation syndrome.

So there are definitely some very good options for urticaria. And to Maria’s point, yes, it’s not something that you hear a lot about. But for someone who’s suffering with hives, it can certainly be frustrating and maybe, at times, a little bit embarrassing. And while there are some simple options of over-the-counter antihistamines, there are also some more natural and fundamental treatments that may help you feel better.

Now, as a quick example, if someone was to derive benefit for urticaria from a low FODMAP diet, there’s a very good chance that they’ll also see other improvements. Potentially, they’ll be less bloated or have better formed stools, potentially less brain fog, better energy or less irritability. All these things can be achieved from rectifying the levels of histamine in your body. One way of which you can do that is through a low FODMAP diet.

So, again, urticaria or hives is something that can be problematic. But again, Maria, yes, you’re right, this is a condition that’s not often talked about. But fortunately, there are some very helpful therapies that come back to this philosophy of starting with your gut. And if you do that, I think you have a good probability of coming out on top.

So, this is Dr. Ruscio. And I hope this information helps you get healthy and get back to your life. Thanks.

What do you think? I would like to hear your thoughts or experience with this.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut-related disorders such as SIBO, leaky gut, Celiac, and IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco Bay area and distance patients via phone and Skype.

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

32 thoughts on “How to Resolve Chronic Hives – Audience Question

  1. I wish my allergist would listen to this. Several years ago I started having problems with urticaria and angioedema . My doctor ran the typical allergy tests and asked about my diet (I was eating a primarily primal diet at the time). There was no rhyme or reason that I could find, no new foods, body products, or any other potential sources for the reactions, and no pattern related to what I was eating. The tests did not reveal any issues, either. So, he labeled the problem as ideopathic and put me on a prescription antihistamine. That worked for a little while, though if I skipped even a single dose, I’d wake up the next day covered in hives. Eventually, even if I *didn’t* miss a dose, I would still get an occasional break through of hives (though not as bad as if I’d missed the dose). I went back to the doctor and suggested that the problem might be related to a gut imbalance. He poo pooed that suggestion and said there was no cause and to just start taking an over the counter antihistamine in addition to the the prescription one and eventually it would just “clear up on its own”.

    At that point, I got angry and called him a shill for the pharmaceutical companies. (rather loudly, I’m afraid. so I’m sure his patients in the waiting room heard me). He objected saying he didn’t make any money by prescribing me medications (apparently he has never read a definition of what a shill is). At that point, I stormed out of his office and went in search of a functional medicine doctor. I was able to find one near me and she tested me for gut imbalances and sure enough, I had several bacteria that were either too plentiful or not plentiful enough. So, we worked on a plan that included both dietary changes and supplements to bring the bacteria level back in line. The supplements included both ones to reduce the bad bacteria and probiotics to increase the good bacteria. I stayed on the antihistamines initially. When I tried weaning off them, the hives would start to come back. Once we had effectively reduced the presence of the bad bacteria, I switched my probiotics to a double dose of Mega Sporebiotic to repopulate the gut with good bacteria. The Mega Sporebiotic is what finally did the trick and allowed me to completely stop the antihistamines.

    Now, I am down to a standard dose of Mega Sporebiotic and help keep my gut healthy by regularly drinking homemade bone broth. I’ve also eliminated all grains (even gluten free ones) and starchy vegetables. I only eat fruit occasionally and try to stick with the lower sugar fruits like blackberries, raspberries and strawberries. I haven’t had a single recurrence of the urticaria or edema since.

  2. Hi DR Ruscio.
    I too have Uticaria with added pressure. Hives. Itching. Now small red bumps on my trunk area. I hv been diagnosed w connective tissue disease. The itching for some time now is mostly on my back. I had a herniation approx 2 years ago. The itching and soreness seems to have settled in my lumbar area. That seems to be when all of my issues began. I also had 2 injections. It has been a long 2 years. I am writing for your opinion. Maybe we are missing something?? Prior to that I was active and healthy.
    Thank you for any input!

    1. Hi Marlene,
      Well I laid out some treatment options you could try in this post. My book will also walk you through some expanded options for improving your gut health. You could also see the interview on my site with Dr. Afrin. Lots of options for you 🙂

  3. What about natural supplements like histablock? Be as helpful as pharmaceutical antihistamines or it really depends on the person?

  4. I wish my allergist would listen to this. Several years ago I started having problems with urticaria and angioedema . My doctor ran the typical allergy tests and asked about my diet (I was eating a primarily primal diet at the time). There was no rhyme or reason that I could find, no new foods, body products, or any other potential sources for the reactions, and no pattern related to what I was eating. The tests did not reveal any issues, either. So, he labeled the problem as ideopathic and put me on a prescription antihistamine. That worked for a little while, though if I skipped even a single dose, I’d wake up the next day covered in hives. Eventually, even if I *didn’t* miss a dose, I would still get an occasional break through of hives (though not as bad as if I’d missed the dose). I went back to the doctor and suggested that the problem might be related to a gut imbalance. He poo pooed that suggestion and said there was no cause and to just start taking an over the counter antihistamine in addition to the the prescription one and eventually it would just “clear up on its own”.

    At that point, I got angry and called him a shill for the pharmaceutical companies. (rather loudly, I’m afraid. so I’m sure his patients in the waiting room heard me). He objected saying he didn’t make any money by prescribing me medications (apparently he has never read a definition of what a shill is). At that point, I stormed out of his office and went in search of a functional medicine doctor. I was able to find one near me and she tested me for gut imbalances and sure enough, I had several bacteria that were either too plentiful or not plentiful enough. So, we worked on a plan that included both dietary changes and supplements to bring the bacteria level back in line. The supplements included both ones to reduce the bad bacteria and probiotics to increase the good bacteria. I stayed on the antihistamines initially. When I tried weaning off them, the hives would start to come back. Once we had effectively reduced the presence of the bad bacteria, I switched my probiotics to a double dose of Mega Sporebiotic to repopulate the gut with good bacteria. The Mega Sporebiotic is what finally did the trick and allowed me to completely stop the antihistamines.

    Now, I am down to a standard dose of Mega Sporebiotic and help keep my gut healthy by regularly drinking homemade bone broth. I’ve also eliminated all grains (even gluten free ones) and starchy vegetables. I only eat fruit occasionally and try to stick with the lower sugar fruits like blackberries, raspberries and strawberries. I haven’t had a single recurrence of the urticaria or edema since.

  5. Hi DR Ruscio.
    I too have Uticaria with added pressure. Hives. Itching. Now small red bumps on my trunk area. I hv been diagnosed w connective tissue disease. The itching for some time now is mostly on my back. I had a herniation approx 2 years ago. The itching and soreness seems to have settled in my lumbar area. That seems to be when all of my issues began. I also had 2 injections. It has been a long 2 years. I am writing for your opinion. Maybe we are missing something?? Prior to that I was active and healthy.
    Thank you for any input!

    1. Hi Marlene,
      Well I laid out some treatment options you could try in this post. My book will also walk you through some expanded options for improving your gut health. You could also see the interview on my site with Dr. Afrin. Lots of options for you 🙂

  6. What about natural supplements like histablock? Be as helpful as pharmaceutical antihistamines or it really depends on the person?

  7. Hello, I was just reading an article about how people with histamine intolerance can have low DAO…what do you think about DAO supplements?

  8. Hello, I was just reading an article about how people with histamine intolerance can have low DAO…what do you think about DAO supplements?

  9. Hello, where do I start? I have had the hives for about 6 years now and they are coming stronger and stronger every time I get them. I have passed out at my home when I broke out. Since then I have been on Singlar and Claritin and I still break out. Reading this makes me think I have a cure to my hives. As I sit in the doctors office I say writing this waiting to see him about my hives. Please share more info with me.

  10. Hello, where do I start? I have had the hives for about 6 years now and they are coming stronger and stronger every time I get them. I have passed out at my home when I broke out. Since then I have been on Singlar and Claritin and I still break out. Reading this makes me think I have a cure to my hives. As I sit in the doctors office I say writing this waiting to see him about my hives. Please share more info with me.

  11. I dealt with chronic hives for about two years. They’d come and go whenever they felt like it. Since I’ve been on a low histamine diet, I haven’t had as many outbreaks.

  12. I dealt with chronic hives for about two years. They’d come and go whenever they felt like it. Since I’ve been on a low histamine diet, I haven’t had as many outbreaks.

  13. can you suggest product for “supplement of DAO”? I am from Australia and suffering from urticaria last 5 years. I have already reading your book and started low Histamine diet & Low FODMAP diet.

    1. Hi Sudipta,

      Dr Ruscio hasn’t found DAO supplements to be highly effective, so we don’t have one to recommend. Many patients see a greater response from low FODMAP/low histamine diet, so stick with that for a while and see how it goes. Good luck!

  14. Dear Dr Ruscio,
    Is chronic spontaneous urticaria (CSU) the same as histamine intolerance in terms of a diagnosis? Two different senior Immunologist’s both say I have CSU, however they are sugesting completely different treatment approaches.

    One has me (with the help of a senior Dietician) on a low chemical elimination diet. After 3 weeks on the diet I’m now free of the daily presentation of hives and angioedema, when waking up in the morning. Plus I have seen great improvement in the other longer term symptoms which I didnt know were possibly related (diarrhoea, reflux, very painful periods, anxiety, brain fog, headaches). I have started the “challenges” one at a time and the symptoms have returned with introduction of certain chemicals. The aim is to expand my diet.

    However the other Immunogist has told me that diet plays no role in CSU and says that I qualify for Omalizumab therapy and suggests I go down that route.

    I’m wondering if my diagnosis is actually just histamine intolerance and not CSU? Our main priority is pregnancy as I’m 39. The diet low chem elmination diet has improved my period pain, unlike the endometriosis resection mid year. Can you suggest any studies to look at fertility improving once histamine intolerance or CSU is treated?

    Any thoughts would be most appreciated!!!

  15. Dear Dr Ruscio,
    Is chronic spontaneous urticaria (CSU) the same as histamine intolerance in terms of a diagnosis? Two different senior Immunologist’s both say I have CSU, however they are sugesting completely different treatment approaches.

    One has me (with the help of a senior Dietician) on a low chemical elimination diet. After 3 weeks on the diet I’m now free of the daily presentation of hives and angioedema, when waking up in the morning. Plus I have seen great improvement in the other longer term symptoms which I didnt know were possibly related (diarrhoea, reflux, very painful periods, anxiety, brain fog, headaches). I have started the “challenges” one at a time and the symptoms have returned with introduction of certain chemicals. The aim is to expand my diet.

    However the other Immunogist has told me that diet plays no role in CSU and says that I qualify for Omalizumab therapy and suggests I go down that route.

    I’m wondering if my diagnosis is actually just histamine intolerance and not CSU? Our main priority is pregnancy as I’m 39. The diet low chem elmination diet has improved my period pain, unlike the endometriosis resection mid year. Can you suggest any studies to look at fertility improving once histamine intolerance or CSU is treated?

    Any thoughts would be most appreciated!!!

  16. can you suggest product for “supplement of DAO”? I am from Australia and suffering from urticaria last 5 years. I have already reading your book and started low Histamine diet & Low FODMAP diet.

    1. Hi Sudipta,

      Dr Ruscio hasn’t found DAO supplements to be highly effective, so we don’t have one to recommend. Many patients see a greater response from low FODMAP/low histamine diet, so stick with that for a while and see how it goes. Good luck!

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