Hives (Urticaria)

What Causes Hives?

To successfully treat and prevent recurrence of hives we need to understand and — if possible — remove the underlying causes and risk factors.  We need to ask: "What else is going on inside the body that might allow hives to develop?"

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Accurate diagnosis of the factors behind hives consists of three steps:

Step 1: List the Possible Causative Factors

Identify all disease conditions, lifestyle choices and environmental risk factors that can lead to hives.  Here are seven possibilities:
  • Food Allergies
  • Chronic Thyroiditis
  • Aspartame/Neotame Side-Effects
  • Autoimmune Tendency
  • Stress
  • Adrenal Fatigue
  • Milk Allergy

Step 2: Build a Symptom Checklist

Identify all possible symptoms and risk factors of each possible cause, and check the ones that apply:
short-term memory failure
low energy/stamina
frequent episodes of diarrhea
diminished perspiration
history of adult allergies
low systolic blood pressure
bags under eyes
very angry/hostile disposition
slight stiff neck
significant epigastric pain
very frequent stools
... and more than 150 others

Step 3: Rule Out or Confirm each Possible Cause

A differential diagnosis of your symptoms and risk factors finds the likely cause of hives:
Cause Probability Status
Stress 97% Confirm
Food Allergies 21% Unlikely
Adrenal Fatigue 14% Unlikely
Autoimmune Tendency 4% Ruled out
Milk Allergy 3% Ruled out
Aspartame/Neotame Side-Effects 1% Ruled out
Chronic Thyroiditis 0% Ruled out
* This is a simple example to illustrate the process

Arriving at a Correct Diagnosis

The Analyst™ is our online diagnosis tool that learns all about you through a straightforward process of multi-level questioning, providing diagnosis at the end.

If you indicate suffering allergic/other reactions, The Analyst™ will ask further questions including this one:
Have you ever suffered significantly or repeatedly from hives?
Possible responses:
→ One or two minor incidents / don't know
→ No, never
→ A significant problem in the past only
→ Occasionally / moderately
→ Often / severely
Based on your response to this question, which may indicate no history of urticaria, history of urticaria, urticaria or severe urticaria, The Analyst™ will consider possibilities such as:
Allergy to Foods (Hidden)

Foods and drugs are common causes of hives.  A reaction that occurs immediately after ingestion of certain foods, producing hives and difficulty breathing is termed anaphalactic and is potentially dangerous.  Delayed reactions are less serious but more difficult to pinpoint.  Some patients get hives occasionally only when they ingest a specific food or food additive.  Others develop hives as a chronic problem that can continue for years.  Most studies of chronic hives suggest that only a low percentage are due to food allergy; this is usually because diet revision attempts were inadequate for revealing the hidden food causes.

Autoimmune Tendency

Some forms of chronic hives have an autoimmune origin which means, in about 30% of patients, that the immune system is producing antibodies against normal substances in the body and triggering the release of histamine by mast cells. [Journal of the American Academy of Dermatology, March 1999, 40(3); pp.443-450]

Chronic Thyroiditis

Amongst patients with chronic hives and either treated hypothyroidism or a normally functioning thyroid gland, it is reasonable to test for anti-thyroid antibodies.  In a study of 10 patients with chronic hives, thyroxine (T4) was administered for a minimum of 12 weeks.  Of 7 patients with elevated anti-thyroid antibodies at baseline, all had complete resolution of hives or marked improvement within 4 weeks.  Two patients required an increase in the thyroxine before complete resolution was seen.  In 2 others, already on thyroxine therapy for hypothyroidism, an increase in the dose also resulted in resolution of the hives.

The initial dose was on average 100mcg per day, which was increased if the initial dose failed to produce clinical improvement.  The highest dose used was 250mcg per day.  The 3 patients without elevated anti-thyroid antibodies did not respond to thyroxine therapy.  There was a recurrence of hives after treatment was stopped which resolved again after treatment was restarted.  There was no consistent correlation between improvement in symptoms and reduction in thyroid antibody levels. [J Allergy Clin Immunol 1995;96: pp.901-5]

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