Last Updated on September 4, 2025
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Wondering why your chronic hives urticaria or dermatographia won’t go away? Frustrated and confused because antihistamines and Xolair didn’t work? If chronic hives urticaria, dermatographia or angioedema have got you down – I hear ya. They are some of the most common skin rashes my clients have to battle — and fortunately I've seen clients completely stop these awful symptoms by looking for some very specific root causes.
Chronic hives urticaria, dermatographism, and angioedema are extremely frustrating skin conditions, especially when all the testing to look for an environmental, food or pollen allergy doesn’t explain what's going on. (Or avoiding whatever did show up on the testing, doesn't really seem to help!)
If you’re anything like my clients, you probably don’t want to be stuck on endless combos of antihistamines and eating a low histamine diet for the rest of your life.
My clinical experience supporting people with these conditions has shown me that there is a lot more underlying the frustrating skin symptoms than what you’ll hear from your doctor.
I’m going to share with you how I view these conditions from a functional clinical nutrition perspective AND what are first steps you can take to stop chronic hives urticaria that has truly helped my clients. Let's dive in!
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In this episode:
- Why won’t my chronic hives urticaria go away? Hidden triggers keeping you itchy
- Thyroid connection to chronic hives urticaria — the Hashimoto thyroid skin rash
- Research on chronic utricaria + autoimmunity
- Does chronic hives urticaria mean that your body is OVER-producing histamine?
- First 4 steps to get chronic hives urticaria, dermatographia, angioedema to stop
Quotes:
Histamine Overload is a situation where your body is no longer able to handle the immense amount of histamine present.
A 2019 paper noted that 25 to 30 percent of chronic hives urticaria cases also had underlying Hashimoto’s along with anti-TPO antibodies.
261: Chronic Hives Urticaria, Dermatographia + Angioedema: Why Won't They Go Away? (FULL TRANSCRIPT)
Welcome back to episode #261 of the Healthy Skin Show!
In today’s episode, I want to talk about a very frustrating situation for listeners struggling with chronic hives, urticaria, dermatographia, or angioedema, where it’s really unclear, even after extensive allergy testing, what could be triggering this reaction.
The term “chronic hives” includes situations where you get hives (which are more formally called wheals in literature) as well as angioedema (or swelling under the skin).
Dermatographia is another form of urticaria that creates hive-like patterns on the skin due to pressure from anything, even your clothing.
I know how frustrating this condition can be after working with many clients in my virtual practice who just want their chronic hives urticaria and swelling to stop.
Can Chronic Hives Urticaria + Dermatographia Go Away?
Before we dive in too deep, I want to tell you an important point — YES, you can actually totally stop getting chronic hives urticaria, dermatographia, and angioedema.
I've helped countless clients not only put this issue completely into remission without having to do a low histamine diet for life, but also to be able to stop all of their antihistamines and even Xolair!
So yes, you can eat your favorite high histamine goods again — it's absolutely possible.
I saw this because my clients have tried so many things without much improvement — loads of supplements, a low histamine diet (that many admit isn't sustainable), medications, mindfulness, topical creams, rehoming pets, ripping out carpeting and even moving.
I’m reminded of a client named Sonia who struggled with chronic hives urticaria + dermatographia so badly that she couldn’t even wear tight-fitting yoga pants because the pressure alone would trigger an full body outbreak.
Her diet became extremely limited and she started withdrawing from life and social outings. She felt so depressed at the idea that this was going to be her life from here on out.
As I’m sure you can relate, chronic hives urticaria are not fun – and when the situation is severe, urticaria is extremely detrimental to your quality of life.
If you feel stuck by this extremely maddening diagnosis, let’s talk about what could be going on and why you can’t seem to get the chronic hives urticaria to go away!
Do Chronic Hives Mean I Have Histamine Intolerance?
The first thing you need to know about chronic urticaria hives, dermatographia, and even angioedema is that from a functional perspective – they are indicative of some sort of life-altering problem with histamine.
If you've already done a deep dive on Google, you'll probably discover the concepts of Histamine Intolerance, Mast Cell Activation Syndrome (MCAS) and Mastocytosis.
MCAS and Mastocytosis are very severe conditions (with the latter being the most severe form), which often impact multiple body systems and require mast cell stabilizing medications to help.
Most people are generally dealing with something that certainly feels equally life-wrecking, but isn't as severe, presenting more as a histamine intolerance problem.
However, I have frequently argued that histamine intolerance is WAY overdiagnosed in the functional medicine world, leading people to assume that high histamine foods are the culprit.
This leads people to end up on terrible, restricted diets (of varying degrees) that only band-aid the ultimate problem.
I believe that 95% of people with chronic hives urticaria, dermatographia, and angioedema actually have Histamine Overload.
Histamine Overload is a situation where your body is no longer able to handle the immense amount of histamine present.
So your system is essentially swimming in a gigantic pool of histamine that it cannot process fast enough due to a variety of factors.
Sometimes there are genetic SNPs in histamine-degrading enzymes (namely Diamine oxidase (DAO) and Histamine n-methyltransferase (HMNT)), but I should mention that this is not necessarily everyone’s problem especially if the onset is relatively new for you.
Other factors have to do with environmental issues (mold exposure is one of them) that destabilize mast cells as well as gut microbiome dysbiosis with the presence of certain organisms that MAKE histamine.
Yes – you read that right. Certain gut organisms MAKE histamine.
So much, in fact, that your gut actually becomes a histamine production factory that you cannot escape.
High histamine foods only make things worse.
DAO enzyme supplements might not be very helpful (this is actually REALLY common and why I don’t often recommend them anymore).
What if Xolair Doesn't Work For Chronic Hives Urticaria
And so you end up leaning hard on anti-histamine medications (sometimes multiple meds at the same time) and even possibly Xolair, but I've also worked with a lot of cases where they didn't really help.
One client was on 8 doses of antihistamines a day in addition to Xolair every two weeks for her angioedema and chronic hives urticaria — with little to no relief. Even a low histamine diet didn't help! She had significant concerns about taking all these medications especially since it's well-established that long-term use of antihistamines is problematic, including:(1,2,3,4)
- poor sleep
- increased risk of dementia, depression, anxiety and fatigue
- decreased DAO production in the GI tract
- increased risk of acute liver injury
Sometimes even mast cell stablilzing medications won't fully make chronic hives urticaria stop either.
My point here is that until you get to the bottom of what’s creating this Histamine Overload situation, you will likely continue struggling with chronic urticaria.
If this topic interests you further, I have a two-part deep dive on the concept of Histamine Overload – Part 1 is HERE and Part 2 is HERE. This can be a big piece of the puzzle when it comes to figuring out the root cause of your chronic urticaria, dermatographism, and chronic hives.
Thyroid-Autoimmunity-Chronic Hives Connection: The Hashimoto Thyroid Skin Rash
One of the lesser-known connections of chronic hives urticaria is the incidence of an autoimmune thyroid disease known as Hashimoto’s thyroiditis. So if you’ve been struggling with hives for some time, it’s worthwhile to dive down THIS rabbit hole!
Especially since one recent paper from 2019 noted that 25 to 30 percent of urticaria cases also had underlying Hashimoto’s along with anti-TPO antibodies. Additionally, stabilizing thyroid hormone levels with medication was actually helpful in reducing the severity of itching.(5)
It’s also possible to develop hives in a state of hyperthyroidism (overactive thyroid function) due to kinin activation.(5)
And other data suggest a connection between chronic hives and autoimmunity in general.(6) One study from Israel reviewing data from 12,778 patients over the course of 17 years found a strong association between those with chronic urticaria and autoimmune disease.(7)
As for digging deeper into a possible thyroid issue, simply testing TSH alone isn’t enough in this case to identify elevations of antibodies or the presence of Hashimoto’s. The reason is that you can have a normal TSH with the presence of antibodies which is why doing a more extensive panel is prudent.
A full thyroid panel that would be helpful includes TSH, Free T4, Free T3, TPO antibodies, and Thyroglobulin antibodies to help determine if Hashimoto’s is also present. These are a part of the larger panel of blood labs that I recommend clients get (see the full list here).
This all said, many autoimmune conditions share overlapping triggers that can underlie these types of skin issues that I’ve already mentioned.
This can be seen in another 2019 paper which discusses the connections of chronic urticaria hives to celiac disease, insufficient vitamin D levels, asymptomatic H. pylori infections, parasitic infections, and gut microbiome dysbiosis, especially marked by lower levels of key beneficial strains including Akkermansia muciniphila, and Faecalibacterium prausnitzii.(8)
So it’s honestly not all that surprising that hives, thyroid issues, and autoimmunity are potentially linked.
4 Steps For Chronic Hives, Dermatographia, Dermatographic Urticaria Hives + Angioedema
Before I share these tips, I want to be very clear that this is a journey…
If you’re hoping for one thing to solve all of this for you, you will likely be disappointed.
I say this to help you manage your expectations because there’s too much information online that “bandaids” your health by over-promising what a low histamine diet will do. While it certainly can reduce the ups and downs of histamine exposure, it doesn’t solve the underlying issue driving the problem.
Especially when you consider that long-term use of the low histamine diet can result in nutrient deficiencies and food fear (or in some cases, complete hate for the act of eating) which is why if you choose this option, you still have to work on the root causes so that you can transition back to a more normal eating pattern where you can tolerate higher histamine foods.
My approach is different and more nuanced, AND it has helped countless people start to reclaim a more normal life free from all the medications and restricted diets. The first step is managing histamine levels while working to stabilize histamine within the gut. Doing this gives you more runway and flexibility to do the root cause-focused work necessary to stop being so endlessly reactive to histamine.
If you're looking for help with this to figure out what's going on — let's talk!
Here are four steps to start dealing with urticaria, dermatographic urticaria hives, dermatographism, and chronic hives –
#1 – Support your Phase 2 liver detox pathways with the right nutrients
As I’ve already stated, there’s a distinct, undeniable gut-hives connection which unfortunately throws your liver into a state of overwhelm. The waste products and toxins produced by unfriendly and imbalanced gut organisms that hide in cases of chronic hives urticaria and dermatographic urticaria/hives require massive amounts of specific nutrients to process.
You can learn more about this in my Liver Detox-Skin Rash Connection series (Part 1 is HERE, Part 2 is HERE and Part 3 is HERE).
Clients have found amino acids such as glycine extremely helpful, along with my favorite flare-free liver support supplement called P2 Detox Balance. Using them in a therapeutic range is important! So, taking glycine twice a day, between three and five grams, on top of food intake, along with using the P2 Detox Balance, commonly three to four capsules taken twice a day with or without food.
This combo can actually make a huge difference in your ability to tolerate high histamine foods within 4 to 6 weeks. Clients have been able to reintroduce foods they long missed – like strawberries, spinach, avocado and tomatoes.
#2 – Immunoglobulins Are Crucial To Reintroduce High Histamine Foods For Chronic Hives Urticaria
I’ve also seen excellent reductions in histamine reactivity in clients who add oral immunoglobulin supplements to their routine. I discussed the reasons WHY this is helpful in a two-part series on the Healthy Skin Show – Part 1 is HERE, and Part 2 is HERE.
These supplements likely will be used at a higher dose than what’s listed on the bottle (and can be very helpful when taken before bed if you start developing hives at night) since the immunoglobulins help to drive down the IgE response happening in the GI tract.
My #1 immunoglobulin product to recommend is available here. You can see how helpful they can be from Amy’s experience!
When you combine immunoglobulins with the right liver support (that I just mentioned), it’s amazing how your tolerance to histamine can substantially improve so you can expand your diet and work on those underlying root causes.
#3 – Add In Histamine Supportive Vitamin C WITH Bioflavinoids…
For every client struggling with chronic hives urticaria, I recommend high doses of Vitamin C WITH bioflavonoids (2500-3000mg/day).
Most people encounter the problem of peeing out the Vitamin C they take, thus wasting their money.
Why?
Your gut has a limit to how much Vitamin C it can absorb at one time – specifically 500mg. If you take more than the limit, you’ll pee out whatever is above the 500mg dose.
So either you take this multiple times a day OR you take a liposomal form that must stay refrigerated (so it’s unfortunately another thing to remember).
#4 – Pinpoint Your Chronic Hives Urticaria Root Causes!
If you’re not sure how to get started, my Skin Rash Root Cause Finder eGuide is a HUGE help. (And it’s FREE!)
This is important because what you don’t want to do is ONLY use the other bandaids above and assume you’re stuck like this for life.
It is absolutely possible to stop urticaria. I’ve seen this happen in countless clients who felt like they were doomed.
And if you need help figuring all this out, my virtual clinic works with chronic hives urticaria clients worldwide. Schedule a Skin Repair Assessment Call here!
When Your Hives Won't Go Away
If you remember my client Sonia, whom I mentioned at the beginning of this episode, struggling with highly reactive chronic hives urticaria and dermatographia. Once I helped her figure out what her root causes were making her skin so reactive, she worked through my method using my Skin Rash Rebuild (SRR) program, and got her life back!
Read her personal testimony here:
She is just one of many clients who have found this process that I created to be life-changing — back to their healthy self without worry of chronic hives urticaria anymore.
Now that you know there is no quick fix, I hope you can see that it is possible to regain your tolerance to histamine, eat all the foods you love, wear tight clothes, move from the cold AC to a hot summer day without issue, sleep through the night, and frankly get on with your life!
If you're ready to figure out your root causes, there is a pathway that's waiting for you to finally be free.
It's an honor to help you connect with the answers you're looking for!
Want to learn more about Histamine Overload and dive DEEP into this topic?
REFERENCES
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- https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2091745
- https://pubmed.ncbi.nlm.nih.gov/24673474/
- https://www.ncbi.nlm.nih.gov/books/NBK547896/
- https://www.deficitdao.org/en/dao-deficiency/origin-of-dao-deficiency/pharmacological-factors/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302681/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302681/
- https://pubmed.ncbi.nlm.nih.gov/22336078/
- https://aacijournal.biomedcentral.com/articles/10.1186/s13223-019-0372-z
