Milly Gaines
Hives, also known as urticaria, are itchy skin welts that can be as small as a fingertip or as large as a dinner plate. They are usually caused by an allergic reaction, but they can also be caused by stress, exercise, temperature changes, and sunlight. While food allergies are a rare cause of chronic hives, certain foods may trigger or worsen hives in some people. This is because some foods contain higher levels of histamine, which the immune system releases in response to a threat or an allergic reaction. A low-histamine diet may help reduce histamine levels in the body and manage hives. Additionally, pseudoallergen elimination diets have proven effective in reducing hives and causing complete or partial remission.
| Characteristics | Values |
|---|---|
| Hives lasting less than 6 weeks | Acute urticaria |
| Hives lasting 6 weeks or more | Chronic urticaria |
| Hives with no known cause | Chronic idiopathic urticaria (CIU) |
| Hives with an identifiable cause | Chronic spontaneous urticaria (CSU) |
| Foods that may trigger hives | High in histamines, pseudoallergens |
| Dietary changes that may help | Low-histamine diet, pseudoallergen elimination diet |
| Lifestyle changes that may help | Stress reduction, loose clothing, avoiding extreme temperatures |
| Medical treatments | Antihistamines, corticosteroids, epinephrine (for severe cases) |
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What You'll Learn
Pseudoallergens and histamine-releasing foods
While food allergies are rarely connected to chronic hives, pseudoallergens and histamine-releasing foods can cause reactions that resemble true allergic reactions, including hives. Histamine is a chemical signal that opens up your blood vessels, constricts your airways and gastrointestinal (GI) tract, and creates mucus. Mast cells in your mucous membranes release histamine and other chemical signals to help fight infections and regulate your organs.
Histamine intolerance occurs when your body can't break down histamine. It is estimated that approximately 1% of the population has a histamine intolerance. While the reasons for this are unclear, some speculate that it could be due to reduced activity or low levels of the DAO enzyme, which is responsible for breaking down histamine.
Histamine-rich foods can cause DAO enzymes to function improperly, and some foods can block DAO enzymes or trigger histamine release. Foods that involve an aging or fermentation process, such as wine, beer, and cheese, tend to have higher histamine levels. Additionally, some fruits, vegetables, seafood, and processed meats can also contain histamine-like substances or trigger histamine release.
If you suspect that certain foods are triggering your hives, you can try an elimination diet. This involves removing potential triggers from your diet for a period of time and then slowly reintroducing them to identify any reactions. It is important to consult a healthcare professional before making any significant changes to your diet.
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Food allergies and immunological reactions
Food allergies are immunological reactions that occur shortly after eating a certain food. Even a small amount of the food that causes an allergy can trigger symptoms such as digestive problems, hives, difficulty breathing, or even a life-threatening reaction known as anaphylaxis. Food allergies are one of the many adverse reactions to food that a person can develop. Food intolerance is a less severe adverse reaction that does not involve the immune system. These intolerances may be due to a direct effect of the food itself or due to digestive issues. Food allergies occur when the body's immune system reacts to specific proteins in food. Food allergic reactions vary in severity from mild symptoms involving hives and lip swelling to severe, life-threatening symptoms, often called anaphylaxis, that may include fatal respiratory issues and shock. An allergic reaction to a particular food may be uncomfortable but not severe for some people.
When it is a food allergy, one is at risk of a life-threatening reaction if they eat the food, and so one must be obsessive about reading labels and asking questions to make sure they are avoiding it. When one has a food allergy, their immune system mistakenly identifies a specific food or a substance in food as something harmful. In response, the immune system triggers cells to generate a type of antibody known as immunoglobulin E (IgE) directed against the allergy-causing food or food substance (the allergen). The next time one eats even the smallest amount of that food, IgE antibodies sense it and signal the immune system to release chemicals such as histamine, in the body. These chemicals cause the allergy symptoms.
If a specific food is the suspected trigger, an allergist may do a skin-prick test or a blood test to confirm the diagnosis; once the trigger is identified, one will likely be advised to avoid that food and products made from it. In rare instances, the allergist may recommend an oral food challenge – a carefully monitored test in which one will eat a measured amount of the suspected trigger to see if hives develop. If a medication is suspected as the trigger, an allergist can conduct similar tests, and a cautious drug challenge – similar to an oral food challenge, but with medications – may also be needed to confirm the diagnosis. Because of the possibility of anaphylaxis, a life-threatening allergic reaction, these challenge tests should be done only under strict medical supervision, with emergency medication and equipment at hand.
If one chooses to eliminate food from their diet and notices that their hives are better, they should make sure to add that food back to their diet to see if their hives get worse. If one has chronic hives, they may think that what they eat is to blame, but an allergist explains how food allergies are rarely connected to chronic hives. Rarely do food allergies cause chronic hives. People who have chronic hives typically experience welts and bumps on their skin and even angioedema, which is swelling of the skin. But one shouldn’t have any internal swelling – throat tightness, difficulty breathing, chest tightness, wheezing, abdominal pain, nausea, and vomiting. People who have hives and one of those other symptoms are diagnosed with anaphylaxis, a severe allergic reaction.
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Non-immunological food intolerances
Food allergies rarely cause chronic hives, according to allergists. However, some people may have a hypersensitivity or intolerance to certain foods, resulting in reactions that resemble true allergic reactions, including hives.
Food intolerance is a non-immunological response to a food or food component at a dose that is usually tolerated. It accounts for most adverse food responses. Food intolerance is estimated to affect up to 20% of the population.
There are a variety of non-immunological food intolerances, including:
- FODMAP sensitivity: This is caused by fermentable oligo-, di-, mono-saccharides and polyols, which are naturally occurring in a wide variety of foods. FODMAP sensitivity leads to increased osmotic activity and fermentation, resulting in symptoms such as distention and visceral hypersensitivity.
- Non-coeliac gluten/wheat sensitivity: There is limited evidence on the mechanisms, diagnosis, and management of this intolerance.
- Food additives and bioactive food chemicals: These include synthetic and natural substances that cannot be consumed alone as food. A small number of additives have been linked to immunological or non-immunological adverse reactions.
Elimination Diets
To identify and manage non-immunological food intolerances, elimination diets are often recommended. This involves avoiding potential triggers for several weeks and then slowly reintroducing them to identify specific intolerances.
For example, a 2010 study of chronic spontaneous urticaria found that approximately 1 in 3 participants responded positively to a pseudoallergen-free elimination diet lasting 3 weeks.
It is important to note that the connection between diet and chronic hives is complex, and there is no one-size-fits-all approach. While some people may find relief from hives by eliminating certain foods, others may not see any improvement.
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Lifestyle adjustments
While food allergies are rarely connected to chronic hives, certain foods may trigger or worsen hives in some people due to the reaction they cause within the body. A low-histamine diet that includes foods with lower histamine levels and eliminates those with higher levels may help reduce histamine levels in the body and manage hives. A 2018 study found that a low-histamine diet resulted in reduced severity of hives and a significant reduction in histamine levels in the blood.
Additionally, pseudoallergen elimination diets have proven effective in reducing hives and causing complete or partial remission. Pseudoallergens are substances that can cause reactions resembling true allergic reactions, such as hives, even if a person tests negative for food allergies. A 2010 study found that approximately 1 in 3 participants with chronic spontaneous urticaria responded positively to a pseudoallergen-free diet lasting 3 weeks.
- Stress reduction: Stress is a common trigger for chronic hives, so focusing on stress management techniques, such as relaxation, getting enough sleep, staying active, and seeking support from others, may help reduce the occurrence of hives.
- Clothing choices: Wearing softer, loose-fitting, and lightweight clothing can help reduce irritation and discomfort associated with hives.
- Sun protection: Avoiding excessive sun exposure and using sun protection, such as wearing protective clothing and applying sunscreen, can help manage hives, especially during the summer months.
- Temperature control: Avoiding extreme changes in temperature can help prevent hives, as both hot and cold temperatures can trigger flare-ups.
- Dietary modifications: While the connection between diet and chronic hives is not well-established, some people may find relief by following a low-histamine diet or a pseudoallergen elimination diet under the guidance of a healthcare professional. It is important to note that dietary restrictions should not be undertaken for extended periods without professional advice, as they may result in the restriction of important nutrients, vitamins, and minerals.
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Elimination diets
Although food allergies are rarely connected to chronic hives, some doctors recommend a pseudoallergen elimination diet for Chronic Idiopathic Urticaria (CIU) or hives that last at least 6 weeks with no known underlying cause. This involves avoiding potential pseudoallergens for several weeks and slowly reintroducing them to identify triggers.
A 2010 study of a type of CIU called chronic spontaneous urticaria found that approximately 1 in 3 participants responded positively to a pseudoallergen-free diet lasting 3 weeks. However, it is important to note that there is currently limited research and conflicting opinions on the effectiveness of elimination diets for chronic hives.
If you choose to eliminate foods from your diet, it is recommended to slowly reintroduce them to see if your hives get worse. It is also important to work with a healthcare professional when trying an elimination diet to avoid nutritional deficiencies and ensure proper guidance.
Some common food triggers for hives include food dyes, preservatives, additives, alcohol, tomatoes, seafood, fruits and fruit juices, herbs and spices, candy, and chewing gum. In addition to dietary changes, lifestyle adjustments such as stress reduction, wearing softer clothing, and staying out of the sun can also help manage hives flares.
While food allergies are not a common cause of chronic hives, they can trigger acute hives, which are hives that do not last longer than a few weeks. If you suspect a food allergy is causing your hives, it is important to consult a healthcare provider, who can help identify triggers through allergy tests and develop a personalized treatment plan.
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Frequently asked questions
Hives, also known as urticaria, are itchy skin welts that can vary in size. They usually fade within 24 hours but can be noticeable for several days or longer.
Hives are often a sign of an allergic reaction or an acute immunological reaction. They can be triggered by food allergies, stress, sunlight, or extreme temperatures.
Food allergies are rarely the cause of chronic hives. However, certain foods may trigger hives in some people due to the body's reaction to them. These include foods high in histamines and pseudoallergens.
If you suspect that your diet is causing your hives, it is important to speak with a healthcare professional. They may recommend an elimination diet, where you avoid potential triggers for several weeks and slowly reintroduce them to identify any food sensitivities.
Antihistamines are the first-line treatment for hives. Lifestyle adjustments such as stress reduction, wearing softer clothing, and staying out of the sun can also help manage symptoms.
