Hives

Also indexed as: Angioedema, Urticaria

Hives (urticaria) is an allergic reaction in the skin characterized by white or pink welts or large bumps surrounded by redness. These welts are known as wheal and flare lesions and are caused primarily by the release of histamine (an allergy mediator) in the skin. About 50% of people with chronic hives develop angioedema—a deeper, more serious form of hives involving the tissue below the surface of the skin.

While the basic cause of hives involves the release of histamine from white blood cells, what actually triggers this release can be a variety of factors, such as physical contact or pressure, heat (prickly heat rash), cold, water, autoimmune reactions, infectious organisms (e.g., hepatitis B virus, Candida albicans, and streptococcal bacteria), and allergies or sensitivities to drugs (especially antibiotics and aspirin), foods, and food additives.

Checklist for Hives

Rating Nutritional Supplements Herbs
1Star Betaine HCl
Vitamin B12
Vitamin B-complex
Vitamin C		 Green tea
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of hives? Symptoms include an itchy skin rash with red bumps that can appear on the face, trunk of the body, and, sometimes, on the scalp, hands, or feet. Individual lesions usually last less than 24 hours and can change shape, fade, and then rapidly reappear. People with hives may also have wheezing, or swelling of the eyelids, lips, tongue, or throat.

How is it treated? Conventional treatment includes medications, such as antihistamines (e.g., hydroxyzine [Atarax®], diphenhydramine [Benadryl®], doxepin [Sinequan®, Adapin®], loratadine [Claritin®], cyproheptadine [Periactin®], and cetirizine [Zyrtec®]), to relieve the rash and itching. In serious cases, doctors may also prescribe cortisone-like drugs (e.g., prednisone [Deltasone®, Orasone®, and Meticorten®]).

Dietary changes that may be helpful: Allergy to foods and food additives is a common cause of hives, especially in chronic cases.1 The foods most often reported to trigger hives are dairy products, eggs, chicken, cured meat, alcoholic beverages, chocolate, citrus fruits, shellfish, and nuts.2 3 4 Food additives that have been shown to trigger hives include colorants (azo dyes), flavorings (salicylates), artificial sweeteners (aspartame), preservatives (benzoates, nitrites, sorbic acid), antioxidants (hydroxytoluene, sulfite, gallate), and emulsifiers/stabilizers (polysorbates, vegetable gums).5 6 7 Numerous clinical studies demonstrate that diets that are free of foods or food additives that commonly trigger allergic reactions typically produce significant reductions in symptoms in 50–75% of people with chronic hives.8 9 10 11 People with hives not clearly linked to a known cause should discuss the possibility of food allergies with a doctor.

Nutritional supplements that may be helpful: In theory, high amounts of vitamin C might help people with hives by lowering histamine levels.12 Amounts of at least 2,000 mg daily appear necessary to produce these effects.13 No research trials have yet explored the clinical effects of vitamin C supplementation in people with hives.

Vitamin B12 has been reported to reduce the severity of acute hives as well as to reduce the frequency and severity of outbreaks in chronic cases.14 15 The amount used in these reported case studies was 1,000 mcg by injection per week. Whether taking B12 supplements orally would have these effects remains unknown. On rare occasions, vitamin B12 injections cause hives in susceptible people.16 Whether such reactions are actually triggered by exposure to large amounts of vitamin B12 or to preservatives and other substances found in most vitamin B12 injections remains unclear.

According to preliminary studies from many years ago, lack of hydrochloric acid (HCl) secretion by the stomach was associated with chronic hives, presumably as a result of increasing the likelihood of developing food allergies. In one such study, 31% were diagnosed as having achlorhydria (no gastric acid output), and 53% were shown to be hypochlorhydric (having low gastric acid output).17 In a related study, treatment with an HCl supplement and a vitamin B-complex supplement helped to treat people with hives.18 Betaine HCl is the most common hydrochloric acid-containing supplement; it comes in tablets or capsules measured in grains or milligrams. One or more tablets or capsules, each containing 5–10 grains (325–650 mg) are typically taken with a meal that contains protein. Diagnosis of a deficiency of HCl and supplementation with HCl should be supervised by a doctor.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Two components of green tea, the polyphenols epigallocatechin (EGC) and epicatechin gallate (ECG),19 are reported to have an antihistamine effect. Some doctors recommend approximately 3 cups of green tea per day or about 3 grams of soluble components providing roughly 240 to 320 mg of polyphenols, although no human trials have studied the effects of green tea in people with hives.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

Other integrative approaches that may be helpful: Psychological stress is often reported as a triggering factor in people with chronic hives.20 Stress may play an important role by decreasing the effectiveness of immune system mechanisms that would otherwise block allergic reactions. In a small preliminary trial of people with chronic hives, relaxation therapy and hypnosis were shown to provide significant benefit.21 People were given an audio tape and asked to use the relaxation techniques described on the tape at home. At a follow-up examination 5 to 14 months after the initial session, six people were free of hives and an additional seven reported improvement.

References:

1. Henz BM, Zuberbier T. Most chronic urticaria is food-dependent, not idiopathic. Exp Dermatol 1998;7:139–42. [review].

2. Winkelmann RK. Food sensitivity and urticaria or vasculitis. In: Brostoff J, Challacombe SJ (eds.) Food Allergy and Intolerance. Philadelphia: WB Saunders, 1987, 602–17. [review].

3. Wraith DG, Merrett J, Roth A, et al. Recognition of food allergic patients and their allergens by the RAST technique and clinical investigation. Clin Allergy 1975;9:25–36.

4. Lewis-Jones MS, Barnes RMR, Macfarlane AW, et al. Frequency and isotype distribution of serum antibodies reactive with dietary proteins in adults with chronic urticaria. Clin Exp Dermatol 1987;12:419–23.

5. Lessof MH. Reactions to food additives. Clin Exp Allergy 1995;25 Suppl 1:27–8. [review].

6. Juhlin L. Additives and chronic urticaria. Ann Allergy 1987;59:119–23. [review].

7. Kulczycki A Jr. Aspartame-induced urticaria. Ann Int Med 1986;104:207–8.

8. Zuberbier T, Chantraine-Hess S, Hartmann K, et al. Pseudoallergen-free diet in the treatment of chronic urticaria. ACTA Dermatologica Venerol (Stockh) 1995;75:484–7.

9. Henz BM, Zuberbier T. Most chronic urticaria is food-dependent, not idiopathic. Exp Dermatol 1998;7:139–42. [review].

10. Verschave A, Stevens E, Degreef H. Pseudo-allergen free diet in chronic urticaria. Dermatologica 1983;167:256–9.

11. Gibson A, Clancy R. Management of chronic idiopathic urticaria by the identification and exclusion of dietary factors. Clin Allergy 1980;10:699–704.

12. Johnston S, Martin LJ, Cai X. Antihistamine effect of supplemental ascorbic acid and neutrophil chemotaxis. J Am Coll Nutr 1992;11:172–6.

13. Johnston S, Martin LJ, Cai X. Antihistamine effect of supplemental ascorbic acid and neutrophil chemotaxis. J Am Coll Nutr 1992;11:172–6.

14. Simon SW. Vitamin B12 therapy in allergy and chronic dermatoses. J Allergy 1951;22:183–5.

15. Simon SW, Edmonds P. Cyanocobalamin (B12): comparison of aqueous and repository preparations in urticaria; possible mode of action. J Am Geriatr Soc 1964;12:79–85.

16. Meyer de Schmid JJ, Zeller J. Urticaria due to vitamin B 12 allergy verified by the lymphoblastic transformation test. Bull Soc Fr Dermatol Syphiligr 1969;76:670–1 [in French].

17. Rawls WB, Ancona VC. Chronic urticaria associated with hypochlorhydria or achlorhydria. Rev Gastroenterol 1951;18:267–71.

18. Allison JR. The relation of hydrochloric acid and vitamin B complex deficiency in certain skin diseases. South Med J 1945;38:235–41.

19. Matsuo N, Yamada K, Shoji K, et al. Effect of tea polyphenols on histamine release from rat basophilic leukemia (RBL-2H3) cells: the structure-inhibitory activity relationship. Allergy 1997;52:58–64.

20. Green G, Koelsche G, Kierland R. Etiology and pathogenesis of chronic urticaria. Ann Allergy 1065;23:30–6. [review].

21. Shertzer CL, Lookingbill DP. Effects of relaxation therapy and hypnotizability in chronic urticaria. Arch Dermatol 1987;123:913–6.