Urticaria (Hives)

Urticaria, commonly known as hives, is a skin condition characterized by the sudden appearance of raised, itchy welts that can be red or skin coloured. These welts can vary in size and shape, often appearing and fading quickly, sometimes within hours. They can occur anywhere on the body and may be accompanied by a burning or stinging sensation

Types of Urticaria

• Acute Urticaria: Lasts less than six weeks and is often triggered by allergic reactions to foods, medications, insect stings, or infections

• Chronic Urticaria: Persists for more than six weeks and may recur over months or years. In many cases, the exact cause remains unknown

About 1 in 5 people who develop chronic hives also have an autoimmune disease, such as:

• Celiac disease. (Celiac disease generates inflammatory responses that could stimulate anti-IgE receptor antibodies, which may activate mast cells. Increased gastrointestinal permeability may permit the increased passage of antigens.)

• Dermatomyositis.

• Diabetes.

• Lupus.

• Polymyositis.

• Rheumatoid arthritis.

• Thyroid disease.

• Vitiligo.

Common Triggers

Urticaria can be caused by various factors, including:

• Allergens: Such as certain foods (e.g.,wheat/gluten, peanuts, eggs, shellfish), medications (e.g., antibiotics, aspirin), and insect stings

• Physical Stimuli: Like pressure, cold, heat, exercise, or sun exposure

• Infections: Both bacterial and viral infections can trigger hives

• Stress: Emotional stress can exacerbate or trigger hives in some individuals

Symptoms

The primary symptom of urticaria is the development of itchy welts that:

• Can appear anywhere on the body

• Vary in size and shape

• May join to form larger areas of raised skin

• Typically blanch (turn white) when pressed

In some cases, urticaria is accompanied by angioedema, which is swelling in the deeper layers of the skin, often around the eyes, lips, hands, or feet.

Treatment and Management

Treatment focuses on relieving symptoms and identifying potential triggers:

• Antihistamines: These medications are commonly used to reduce itching and swelling. Second-generation antihistamines like cetirizine and loratadine are preferred due to fewer side effects.

• Avoiding Triggers: Identifying and avoiding known triggers can help prevent outbreaks.

• Advanced Therapies: For chronic cases unresponsive to antihistamines, treatments like corticosteroids, leukotriene receptor antagonists, or biologics such as omalizumab may be considered.

If you experience hives that persist, recur frequently, or are accompanied by symptoms like difficulty breathing or swelling of the face and throat, it’s essential to seek medical attention promptly, as these may indicate a more severe allergic reaction

The role of vitamin and minerals in Urticaria

Vitamin D is known to play an important role in the regulation of the immune system. Studies indicate that vitamin D deficiency may contribute to increased risk of atopic dermatitis and chronic urticaria. Vitamin D may play a role in both allergies and autoimmune skin diseases, including stopping mast cells from releasing histamine

Iron: A 1975 publication of a study performed in Barcelona was one of the first to propose a relationship between chronic urticaria and low blood iron. Nearly 30% of their patients with chronic urticaria had low iron levels, which was improved or cured in some of these patients after iron treatment.

Vitamin C was historically reported to improve urticaria at doses of 1,000 mg 3 times daily, offering potential benefit.

Vitamin B_12: One-third of patients with chronic urticaria were found to be deficient in vitamin B₁₂;

Flavonoids is an umbrella term for phytonutrients or plant chemicals found in fruits and vegetables. Flavonoids, such as quercetin, may inhibit the release of histamine within in vitro mast cells.

Foods that may help alleviate urticaria symptoms

Managing urticaria, particularly chronic idiopathic urticaria (CIU), often involves dietary adjustments to reduce histamine intake and inflammation. Here’s a comprehensive list of foods that may help alleviate urticaria symptoms:

Low-Histamine Foods

These foods are less likely to trigger histamine-related reactions:

• Fresh Meats: Beef, chicken, lamb (consume freshly cooked; avoid leftovers)

• Fresh Fish: Cod, sole, pollock (ensure freshness; avoid canned or smoked varieties)

• Eggs: Particularly egg yolks; egg whites may be histamine-releasing in some individuals

• Grains: Rice, quinoa, millet, sorghum

• Dairy Alternatives: Almond milk, coconut milk, rice milk

Anti-Inflammatory Vegetables

Incorporating these vegetables can help reduce inflammation:

• Cruciferous Vegetables: Broccoli, cauliflower, cabbage, Brussels sprouts

• Leafy Greens: Lettuce, arugula, kale, spinach (note: spinach may be high in histamine for some individuals)

• Root Vegetables: Carrots, turnips, radishes

• Alliums: Garlic, onions, leeks

Low-Histamine Fruits

These fruits are generally considered low in histamine:

• Apples: Especially green varieties

• Pears: Fresh and ripe

• Melons: Cantaloupe, honeydew, watermelon

• Berries: Blueberries, blackberries (consume in moderation)

Herbs and Spices

Certain herbs and spices have antihistamine and anti-inflammatory properties:

• Turmeric: Contains curcumin, which may help reduce inflammation

• Ginger: Known for its anti-inflammatory effects

• Parsley: May inhibit histamine release

• Basil and Cilantro: Fresh herbs that can add flavour without adding histamines

Nuts and Seeds

Some nuts and seeds are low in histamine and can be included in moderation:

• Chia Seeds: Rich in omega-3 fatty acids

• Flaxseeds: good source of omega-3s

• Pumpkin Seeds: Low in histamine and nutrient-dense

Beverages

Opt for these low-histamine beverages:

• Herbal Teas: Chamomile, rooibos (ensure they are free from additives)

• Coconut Water: Hydrating and generally low in histamine

Managing urticaria, particularly chronic idiopathic urticaria (CIU), often involves identifying and avoiding dietary triggers. While individual responses can vary, certain foods are commonly associated with exacerbating urticaria symptoms. Below is a comprehensive list of such foods, categorized for clarity:

High-Histamine Foods

Histamine is a compound involved in immune responses. Some foods naturally contain high levels of histamine or can trigger its release, potentially worsening urticaria symptoms:

• Aged Cheeses: Parmesan, blue cheese, Gouda

• Fermented Foods: Sauerkraut, kimchi, yogurt, vinegar

• Processed Meats: Salami, pepperoni, hot dogs

• Alcoholic Beverages: Red wine, beer, champagne

• Certain Fish: Tuna, mackerel, sardines, anchovies

• Dried Fruits: Raisins, apricots, dates

• Spinach and Eggplant

• Avocados

Histamine-Releasing Foods

Some foods don’t contain high histamine levels but can stimulate the body to release histamine:

• Citrus Fruits: Oranges, lemons, limes, grapefruits

• Tomatoes

• Strawberries

• Pineapples

• Bananas

• Chocolate

• Nuts: Walnuts, cashews, peanuts

Food Additives and Preservatives

Certain additives can trigger urticaria in sensitive individuals:

• Artificial Colourings: Tartrazine (Yellow No. 5), carmine

• Preservatives: Sodium benzoate, sulphites, BHA, BHT

• Flavour Enhancers: Monosodium glutamate (MSG)

• Artificial Sweeteners: Aspartame

Common Allergens

Some individuals may experience urticaria due to common food allergens:

• Shellfish: Shrimp, crab, lobster

• Fish: Salmon, tuna

• Eggs

• Milk and Dairy Products

• Soy Products: Tofu, soy milk

• Wheat and Gluten-Containing Grains

• Peanuts and Tree Nuts

Other Potential Triggers

Additional foods and substances that may exacerbate urticaria include:

• Yeast-Containing Foods: Bread, beer

• Pickled or Canned Foods

• Smoked Foods: Smoked meats and fish

• Spices: Chili powder, cinnamon, cloves

• Vinegar and Foods Containing Vinegar

Resource Index on Urticaria and Diet

1. Medical News Today – “Chronic Idiopathic Urticaria Diet: Foods to Eat and Avoid”
   This article explores the relationship between diet and chronic idiopathic urticaria, highlighting foods that may trigger or alleviate symptoms.

2. Healthline – “Low Histamine Diet for Chronic Idiopathic Urticaria (CIU)”
   Healthline discusses how a low-histamine diet can help manage CIU symptoms, providing lists of foods to include and avoid.

3. Verywell Health – “What Is a Low-Histamine Diet?”
   This resource explains the principles of a low-histamine diet, detailing which foods are high in histamine and may worsen urticaria.

4. WebMD – “Chronic Hives: Can a Low-Histamine Diet Help?”
   WebMD explores the potential link between histamine-rich foods and chronic hives, offering dietary recommendations.

5. HealthCentral – “The Low-Histamine Diet That Helps with Hives”
   HealthCentral provides insights into how reducing histamine-rich foods can alleviate chronic hives, including practical dietary tips.

6. Nourish – “Foods To Eat To Heal Chronic Hives”
   This article discusses dietary strategies, such as low-histamine and pseudoallergen-free diets, to manage chronic hives effectively.

7. WebMD – “Chronic Spontaneous Urticaria: What to Know”
   WebMD outlines lifestyle and dietary modifications, including the avoidance of pseudoallergens, to treat chronic spontaneous urticaria.

8. PubMed – “Diet and Chronic Urticaria: Dietary Modification as a Treatment Strategy”
   This scientific study examines the impact of dietary changes, such as low-histamine and pseudoallergen-free diets, on chronic urticaria symptoms.

9. PubMed – “Effect of Diet in Chronic Spontaneous Urticaria: A Systematic Review”
   A comprehensive review assessing various dietary interventions and their effectiveness in managing chronic spontaneous urticaria.

10. PubMed – “Dietary Strategies for Chronic Spontaneous Urticaria: An Evidence-Based Review”
    This review provides evidence-based recommendations on dietary modifications, including the elimination of specific food groups, for CSU patients.

11. PubMed – “Nutrition and Urticaria”
    An article discussing the role of nutrition in both acute and chronic urticaria, emphasizing the importance of identifying dietary triggers.

12. MamaHealth – “Diet and Urticaria: Foods to Eat and Avoid for Managing Allergic Reactions”
    MamaHealth provides guidance on dietary choices for managing urticaria, highlighting foods to include and avoid.

13. Johns Hopkins Medicine – “Low Histamine Diet (PDF)”
    This PDF provides a detailed list of foods low in histamine, suitable for individuals managing hives.

14. Dr. Rajani Katta – “The Chronic Idiopathic Urticaria Elimination Diet: The Foods to Avoid If You Have Chronic Hives”
    Dr. Katta outlines foods that may trigger chronic hives and suggests dietary adjustments.

15. Cleveland Clinic – “Can Certain Foods Trigger or Prevent Chronic Hives?”
    Cleveland Clinic discusses the potential impact of specific foods on chronic hives and offers expert opinions.

16. Oshi Health – “The Low Histamine Diet Guide: Foods to Eat and Avoid for Better Health”
    Oshi Health provides a comprehensive guide on low-histamine diets, including foods to eat and avoid, for better health management.

17. Healthline – “Low-Histamine Diet: Which Foods Should I Avoid?”
    Healthline offers detailed information on foods high in histamine and how to manage a low-histamine diet effectively.

18. Verywell Health – “What Is Histamine Intolerance? Everything You Need to Know.”
    This article explains histamine intolerance, its symptoms, and how dietary choices can impact the condition.

19. HealthCentral – “How Histamines Cause Hives and How to Treat and Prevent the Itch”
    HealthCentral discusses the role of histamines in causing hives and offers strategies for treatment and prevention.

20. Allergy & Asthma Network – “Chronic Hives: 10 Actions to Support Your Mental Health”
    This resource provides tips on managing chronic hives and supporting mental health through dietary and lifestyle changes.

21. https://my.clevelandclinic.org/health/diseases/22900-chronic-hives-chronic-idiopathic-urticaria

22. https://www.sciencedirect.com/science/article/abs/pii/S0738081X21002200