chronic urticaria hives

Brought to you by Quell

This episode is bought to you by Quell — to help support rebuilding healthy skin from the outside-in + inside-out!

Take 10% off your next order! Use promo code QUELL10 at check out — Get started HERE!

– – –

If you’ve found it frustrating that no one can tell you why you have chronic urticaria hives (including chronic spontaneous urticaria, dermatographia, and even angioedema), I feel you.

Especially when IgE allergies are ruled out (testing is negative) or even avoiding what you’re allergic to isn’t helpful. At that point, most doctors will say that there is no answer or clear trigger to what causes urticaria, basically leaving you with an increasing number of medications that may or may not help to control your skin.

To say that this leaves many like you feeling enormously helpless and hopeless is an understatement.

In my clinical practice, I’ve worked with many cases of chronic urticaria hives around the globe, helping to troubleshoot when doctors have all but given up in seeking an answer. Some cases have dated back decades, often having been seen at some of the most prestigious health institutions only to be told that there’s nothing to be done beyond antihistamines (which have their own problematic side effects) and biologics like Xolair.

I love helping people stop having hives and urticaria, especially since I get to explore the complex causes of chronic urticaria, which conventional medicine often ignores or assumes is impossible. So when new research starts pointing out connections to what I have seen in practice, I must share it!

If you missed my previous article on hidden causes of chronic urticaria, check it out here! This will help you see that what this new paper demonstrates is highlighting a big missing link to chronic spontaneous urticaria, hives, and other histamine-driven issues.

Before we dig into gut-chronic urticaria hives connection, I highly recommend that you download my Skin Rash Root Cause Finder. This is the exact method I’ve used with thousands of my private clients to help them discover what’s really causing their rash (and yes, this works for hives, dermatographia and angioedema issues) >> Get the easy-to-use Skin Rash Root Cause Finder.

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

In This Episode:

  • Chronic urticaria (hives) gut causes
  • Problems with urticaria treatment options (even Xolair)
  • Gut imbalances noted in chronic spontaneous urticaria (hives)
  • What are lipopolysaccharides + short-chain fatty acids (and why are they important)?
  • Key findings from new research on gut-skin connection (specifically for hives)


“The incidence of true histamine intolerance is much lower than you’re led to believe and is based on old assumptions that need a serious update.”

“Nearly 50% of those living with urticaria experience depression and anxiety (especially when the flare-ups are severe).”


Gut microbiota facilitate chronic spontaneous urticaria

Healthy Skin Show ep. 261: Chronic Hives: Why Aren’t They Going Away

Healthy Skin Show ep. 265: Problem with Antihistamines That No One Tells You w/ Dr. Chris Thompson, MD

Healthy Skin Show ep. 317: Itchy, Painful Rash From Thyroid Disease: Your Guide to Stopping It

Healthy Skin Show ep. 188: Histamine Intolerance + Skin Rashes (PART 1)

anatomical model of the gut

337: New Research On Gut Trigger For Chronic Urticaria Hives (And What I See In Clients) {FULL TRANSCRIPT}

Welcome back to episode 337 of the Healthy Skin Show! In today’s episode, I’m going to talk about new research underscoring a connection between chronic urticaria, hives, and other histamine-driven conditions — AND your gut microbiome.

I’ve discussed various concerns that can trigger hives and chronic urticaria on the show before, including how thyroid issues can play a role, but most of what I’ve come to learn about hives in terms of a gut-skin connection is mostly through research, clinical experience, and trial-and-error.

Because the most common thing I hear from chronic spontaneous urticaria clients is that there’s no clear reason, maybe some unknown allergy – and that they just have to take medication and avoid triggers, many of my clients and Skin Rash Rebuild community members feel hopeless if they were to only follow the conventional route.

And as we learn more about the problems with relying solely on antihistamines as pointed out several times on the Healthy Skin Show, it’s probably not surprising that up to half of patients show insufficient response to treatment with an antihistamine or omalizumab” according to the paper we’ll talk about today published in January 2024 called “Gut microbiota facilitate chronic spontaneous urticaria.” (1)

So let’s talk about what this paper discusses, what I’ve seen in clients, and what this means for you!


woman wondering what causes Urticaria

What Causes Urticaria?

Urticaria is an umbrella term that includes several different histamine-driven skin conditions, including chronic hives, chronic spontaneous urticaria, angioedema, and dermatographia. People develop welts or wheals (or even what looks like raised writings or tracings) on the skin that can result from a variety of triggers, including, but not limited to, pressure, temperature change, exercise, allergen exposure, sunlight, and food.

While the most common course of action is to identify the triggers, many living with chronic urticaria hives discover that allergy testing comes back negative (or they’re already actively avoiding those specific issues). This can be troubling from a conventional standpoint if nothing else seems obvious.

So symptom management is employed with the hope that the urticaria will just stop on its own, but for many, it continues for YEARS and, for some, it continues to get worse.

One client I met with the other week is currently on 4 different antihistamines daily along with the biologic drug Xolair (omalizumab) – and she’s still having breakouts that are disruptive to her quality of life.

Others will try using a low-histamine diet along with more natural anti-histamine supplements (sometimes in addition to urticaria medication) to manage things.

So I appreciated that this research paper highlighted a key problem with the conventional perspective  – namely that at this point in time, there is no clear understanding of what causes urticaria. (1)

Biding time with medications to solely manage symptoms for some future day (that may or may not come) when the hives, swelling, welts, and wheals might stop without looking any further seems… short-sighted. Mostly because those living with urticaria know that they won’t get back the time they’ve lost suffering from this condition, which leads nearly 50% to experience depression and anxiety (especially when the flare-ups are severe). (2)

That’s why I firmly believe that many of these cases of chronic urticaria, hives, dermatographia, etc. have a gut-skin problem that should not go unexplored.


woman with hands above and below her stomach

Chronic Spontaneous Urticaria – Gut Connection

In chronic urticaria clients, I typically find that there are several factors within the gut microbiome that seem to contribute to hives, welts, and wheals. This situation unfortunately helps create what I call Histamine Overload which increases the total amount of histamine your body is exposed to.

Though many in functional and integrative wellness would probably say it’s just histamine intolerance – I actually think the incidence of true histamine intolerance is much lower than you’re led to believe and is based on old assumptions that need a serious update.

The role that the gut microbiome plays in chronic urticaria is complex, and from my clinical experience, it’s larger than just the bacterial imbalances and gut metabolites explored in this paper. But nonetheless, I believe these ideas are worth sharing so that you can begin to recognize other potential issues going on under the surface. (1)

So the authors of “Gut microbiota facilitate chronic spontaneous urticaria” carried out DNA testing of 26 stool samples from patients with chronic spontaneous urticaria who were chosen based on specific criteria discussed in the article. Further testing of different gut metabolites including lipopolysaccharides (LPS) and short-chain fatty acids (SCFA) was completed via plasma (blood samples) which may or may not have the same level of clinical significance as testing the stool samples themselves for these markers. (1)

If you aren’t familiar with lipopolysaccharides (LPS) and short-chain fatty acids (SCFA), allow me a moment to explain them since they are important!

Lipopolysaccharides (also known as LPS) have been mentioned in the past on the Healthy Skin Show because of how intertwined LPS is with systemic inflammation, which often is initiated within the GI tract. When gram-negative bacteria (like E. Coli and Klebsiella pneumonia) are high, they produce LPS, which can lead to a state of endotoxemia—meaning that there is a high level of toxins that are essentially self-produced and can trigger inflammation along with higher levels of gut permeability (aka. Leaky gut). (3)

Short-chain fatty acids (also known as SCFA) are a byproduct of fiber fermentation by your gut bacteria, most notably butyrate, acetate, and propionate. SCFA are important for a variety of reasons, such as increasing or maintaining tight cell junctions in the gut (aka reducing leaky gut), modulating inflammatory signaling, fueling colon cells, etc. (4)

The researchers really focused on the makeup of the different bacteria in the gut and the presence of LPS and SCFAs in those with chronic spontaneous urticaria compared to healthy controls.

So let’s talk about their findings!


woman covering her mouth

Chronic Urticaria Reasons No One Talks About

The researchers found a number of issues from reviewing their stool test DNA and plasma samples data when comparing those with chronic urticaria versus the healthy controls: (1)

  • Lower levels of key beneficial SCFA-producing bacteria in the gut (like Roseburia hominis)
  • Higher levels of potential inflammatory gut bacteria
  • Klebsiella pneumonia was linked to higher urticaria issues
  • LPS was significantly higher (remember – this is an inflammatory endotoxin)

So, to put this bluntly, gut dysbiosis is a factor here, at least through the lens of the bacterial residents. Lower commensal bacteria that make SCFA, plus a higher incidence of bacteria that make LPS, could negatively impact immune regulation within the gut, potentially destabilizing mast cells and triggering the release of histamine.

SCFA are helpful, whereas LPS is not. Plus, higher levels of LPS generally increase gut permeability allowing for things that should really remain in the gut to enter the body potentially triggering inflammatory issues.

One thing you should know is that this paper doesn’t take into account the complexity of the many different types of organisms that make up your gut microbiome. So many gut studies seem to ignore other gut residents including fungi or parasites, which also impact dysbiosis and inflammation. And when it comes to chronic urticaria, hives, and other histamine-driven concerns – fungus (including candida) and parasites must be considered as part of the underlying triggers.

That being said, none of this information about your gut microbiome can be ascertained by allergy testing and blood markers used conventionally to try to determine what causes hives.

The researchers concluded that “this study demonstrates that CSU comes with important and clinically relevant gut microbiome changes including lower levels of SCFA-producing bacteria and higher levels of bacterial LPS-producers. These gut microbiome alterations, by reducing and increasing SCFA and LPS levels, respectively, can facilitate MC-dependent skin inflammation and may drive the development of the signs and symptoms of CSU patients.” (1)

So while this isn’t a smoking gun, it points to an area that is still overlooked and perhaps could offer you an opportunity to work on hidden chronic urticaria triggers while managing symptoms.

After working with so many chronic hives clients, I can confidently say that targeted shifts to the gut microbiome (in conjunction with significant phase 2 liver detox support and other histamine-supportive tools) can make significant improvements in stopping hives.

One of my Skin Rash Rebuild members shared her experience using my method I’ve developed from my years of working with clients to stop hives and dermatographia…

To be able to travel, eat high-histamine foods again, and get your life back is something I take VERY seriously, especially when clients share these wins from the work we do together.

I hope this research excites you just as much as it does me, and I am excited for what’s to come as new studies are done so that hopefully this concept will make its way into how chronic urticaria is addressed.

For now, don’t give up hope – there are so many issues you can explore under the surface that have the potential to help you start getting chronic urticaria, hives, dermatographia, angioedema, and other histamine-driven issues under better control (if not to a point where they go away).

So if you’re looking for help with your chronic urticaria, hives, dermatographia or angioedema case, we consult with adult clients all over the world virtually, so there’s no need to travel to see us in person.


We have a process to assess your case to determine your root causes (including what’s going on in your gut) and support you to rebalance your system with the goal to stop your hives and histamine reactivity.

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

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




chronic urticaria hives