261: Chronic Hives: Why They Aren't Going Away

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If chronic hives, dermatographia or angioedema have got you down – I hear ya.

They are extremely frustrating skin conditions especially when all the testing to look for an environmental trigger doesn’t yield much helpful information.

If you’re anything like my clients, you probably don’t want to be stuck on endless combos of antihistamines and feeling helpless to make this type of rash stop.

My clinical experience supporting people with these conditions has shown me that there are 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 first steps you can take that my clients find incredibly helpful!

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In this episode:

  • The main reason the hives/urticaria will not stop
  • Thyroid connection to chronic hives
  • Research on hives + autoimmunity
  • Is your body OVER-producing histamine?!?!
  • First 4 steps to get urticaria to stop


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 urticaria cases also had underlying Hashimoto’s along with anti-TPO antibodies.


Woman with hives lying in bed scratching her arm

261: Chronic Hives: Why They Aren't Going 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 urticaria or chronic hives 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 hives and swelling to stop.

I’m reminded of a woman named Sonia who struggled with hives + dermatographia so badly that she couldn’t even wear tight-fitting yoga pants because the pressure alone would trigger an outbreak.

As I’m sure you can relate, hives 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 hives to stop!


Woman with hives scratching her arm

Why The Hives Won’t Stop

The first thing you need to know about urticaria, hives, dermatographia, and even angioedema is that from a functional perspective – they are indicative of 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 bugs 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).

And so you end up leaning hard on anti-histamine medications (sometimes multiple meds at the same time) and even possibly the use of mast cell-stabilizing medications (which may or may not help).

Long-term use of antihistamines has its own set of problems 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

You might even try the biologic called Xolair which may or may not help.

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 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.


Woman having her thyroid checked

Thyroid-Autoimmunity-Hives Connection

One of the lesser known connections of hives (chronic 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 Isreal 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 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.


Woman walking on mountain road

4 Steps For Chronic Hives, Dermatographia + Angioedema

Before I share any 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 tries to treat what I’d call “bandaids” as if they are solutions… when they’re not.

These options are bandaids because ultimately you have to address YOUR root cause combo driving Histamine Overload.

But it doesn’t mean that the bandaids aren’t worth trying (often together at the same time) because the reality is that while you’re on this journey, you’ll need tools to help you be more comfortable while you work on the root causes.

Here are four steps to start dealing with urticaria –

#1Support your Phase 2 liver detox pathways with the right nutrients necessary to process toxins that are made by unfriendly gut bugs. You can learn more about why this step is so important 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 liver support supplement called P2 Detox Balance. Using them in a therapeutic range is important! So taking glycine twice a day between three to five grams on top of food intake along with using the P2 Detox Balance commonly three capsules taken twice a day with or without food.

#2 – Immunoglobulins are crucial to help reduce your reactivity! I’ve seen a lot of great results in Histamine Overload clients who add oral immunoglobulin supplements into their routine. I discussed the reasons WHY this is helpful in a two-part series here 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 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 favorite immunoglobulin options called Mega IgG are available in both capsules and powder (which can make taking higher doses easier since it reduces the number of pills you have to swallow).

#3 – Low histamine diet can be helpful… and I say this as someone who really dislikes recommending clients follow elimination diets.

That said, a low histamine diet is a bandaid and will not solve the underlying dysbiosis or Histamine Overload problem.

It will simply help to reduce the amount of histamine-rich (or releasing) foods in your gut which can make you feel better.

But I’m not going to lie… a low histamine diet is hard to follow and limited because the most extreme version eliminates all leftovers.

Long-term use of this 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.

#4 – Start a root cause deep dive! 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.

Let’s return to Sonia whom I mentioned at the beginning of this episode – I’ll let you read for yourself what happened when she finally learned what her root cause combo was using my Skin Rash Rebuild (SRR) program

Sonia's screenshot

And Sonia is not the only person that this process has helped. So yes, there is hope…

It’s not a quick fix, but you can improve your body’s ability to process histamine once again.

If you’ve got any questions or thoughts to share about this, leave a comment below so I can address them.

And share this episode with anyone you know who is struggling with urticaria (and the various forms of urticaria that I mentioned) so they know that they don’t necessarily have to be stuck with it for the rest of their life.

Thank you so much for tuning in and I look forward to diving deeper with you in the next episode!


Woman looking at reference books in library


  1. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2091745
  2. https://pubmed.ncbi.nlm.nih.gov/24673474/
  3. https://www.ncbi.nlm.nih.gov/books/NBK547896/
  4. https://www.deficitdao.org/en/dao-deficiency/origin-of-dao-deficiency/pharmacological-factors/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302681/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302681/
  7. https://pubmed.ncbi.nlm.nih.gov/22336078/
  8. https://aacijournal.biomedcentral.com/articles/10.1186/s13223-019-0372-z

Histamine Overload is a situation where your body is no longer able to handle the immense amount of histamine present.