“Big I, Little I, what begins with I? Ichabod is itchy, so am I.” Dr. Seuss
Last fall I developed itchy welts that would pop out, usually on my forearms, like clockwork every afternoon. Chronic hives, also known as chronic urticaria (CU), was added to my list of maddening symptoms caused by mast cells that behave badly, unleashing symptom producing histamine. Figuring out the triggers for the CU took several months, but I am happy to report that it is under much better control.
The triggers for CU often fall below the radar, but many cases are suspected to be autoimmune, especially if one has autoimmune thyroid disease. Sufferers can experience different types of physical urticaria. In my case I determined that I had delayed pressure urticaria, meaning that when pressure was applied, a short period of time later I would see wheals. Every time I loaded grocery sacks on my forearms I would notice that within 10-15 minutes I would have huge, red welts that were itchy. I also noticed a deep, intense itching, burning, redness and warmth in my feet when I would remove my athletic shoes or when I would first get up in the morning (and sometimes I experienced this in my hands as well). When hives occur below the skin it is called angioedema, and depending on the location of the hives it can be life threatening (think face, lips, throat etc).
CU can also arise from changes in core body temperature, like with exercise, or from contact with water, regardless of the temperature of the water. Some people become symptomatic with exposure to the sun, or conversely from cold, damp weather. Dermatographism arises from firmly rubbing or scratching the skin. CU is diagnosed when one experiences hives for six months or longer. Often symptoms of CU will abate, but they can return unexpectedly.
The main approach to controlling hives is to try to control mast cell release of histamine by avoiding triggers and to take antihistamines. Depending on your symptoms your allergist may prescribe a cocktail of medications to control hives, including H1 and H2 antihistamines, leukotriene inhibitors, doxepin, gastrocrom, and possibly even steroids or an EpiPen if the situation warrants. Some people have found that use of a homemade cream helps. Take ½ cup plain, thick cream (like Eucarin or Cetaphil) and 1 small bottle of over the counter allergy eye drops that contain sodium cromolyn and mix together. Make sure to test this out on skin away from the face, like the forearms, for a few days to determine tolerance.
Diet certainly is a likely suspect when it comes to CU. Following a low histamine diet can help reduce the amount of histamine in the body. In addition to histamine sensitivity, many with CU also have a sensitivity to salicylates. Salicylate is the active ingredient in aspirin, but it is also found in plants, and that means fruits, vegetables and herbal supplements. If you are sensitive to aspirin or other non-steroidal anti-inflammatories (NSAIDS) you may benefit from trying to reduce salicylates in your diet. Just like with the low histamine diet, many fruits are eliminated on the low salicylate diet, except for peeled pears, peeled apples, mangoes and bananas.
Almonds and peanuts are high in salicylates but other tree nuts and seeds are lower in salicylate content (I prefer sunflower seeds, walnuts and cashews). Herbs and spices can vary in their salicylate content and the safest seasoning is considered to be sea salt. Mint seems to be particularly troublesome and that means using a safe toothpaste, like baking soda. Vegetables do contain salicylates but there is little consensus on the safest one. Salicylates are naturally occurring in plant matter, so the amount in plant foods probably varies based on soil, growing region, etc.
Salicylates are also found in many personal care products. Vitamins and herbal products can be very high in salicylates, as can cosmetics, lip balms, and shampoo/conditioner. Pepto Bismol is pure bismuth subsalicylate. Wart removal cream, acne medications/astringents and arthritis/sports creams are also high in salicylate. I have also noticed that gardening and yard work causes over-exposure to salicylates and is a trigger for hives, so wearing gloves and covering up as much as possible is recommended. You can purchase salicylate free personal care products online, like at www.andrearose.com
My approach to dealing with my hives was as follows:
- Get back strictly on my LEAP/MRT diet restrictions. I had developed tolerance to some foods, but during the flare up of CU I had to tighten my restrictions. If you have never tested for food sensitivities or allergies this would be a good starting place.
- Follow a low histamine, low salicylate diet (FYI, my MRT blood test correctly picked up my salicylate sensitivity).
- Look for new sensitivities. In the process of discerning new sensitivities I realized I was now also dairy sensitive. It is sometimes difficult to figure out food sensitivities, but keep a food intake/symptom journal to help decipher the mystery.
- Make sure my vitamin D levels were well within normal range (I recommend this for all of my clients dealing with food sensitivities).
- Take added fish oil/omega 3 supplements. At least one study has shown a positive benefit to supplementation. I did not take a high dose as the study recommended, but I did find that supplementation was part of my healing process.
- Exercise and meditate. Both vigorous exercise and relaxation/mediation are always mainstays in my treatment plan during a flare up. Not only do I feel better, I also have a better mental attitude, which helps the healing process.
- Visit my allergist and take daily anithistamines. I also used the homemade cream on my daily outbreaks and it seemed to calm the hives.
If you are experiencing CU, hang in there. You may not readily know the triggers, but with time and patience you may be able to find the culprits.
By Mary Beth George, MEd, RD/LD, LPC