- Chronic hives often have unknown causes, and various factors beyond stress can be involved, such as food, additives, oxidized oils, infections, and autoimmunity.
- IgE and IgG tests are useful but not foolproof. Pseudoallergens (high-histamine foods and chemicals) and food additives in processed foods are often difficult to detect with these tests.
- We recommend starting with a food diary and a 2-4 week elimination trial, reducing processed foods, oxidized oils, artificial sweeteners, and preservatives to observe changes.
- Checking for internal causes such as H. pylori, thyroid autoimmunity, and mast cell activation is also useful. Treatment options include not only antihistamines but also biologics.
Struggling with Chronic Hives? First, Ask Yourself: 'Is Stress the Only Cause?'
Hives, characterized by raised, intensely itchy skin, significantly reduce quality of life. When symptoms persist for over a month, it's often diagnosed as chronic hives, a condition many people in Japan struggle with. It's common for individuals to be dismissed by doctors with 'it's just stress,' leaving them to manage symptoms with medication without ever finding the root cause. Through our research and practical experience, we've repeatedly seen cases where causes other than stress were hidden.
Food and Testing: The Role and Limitations of IgE and IgG Tests
Immediate (IgE) and Delayed (IgG) Hypersensitivity Tests
IgE antibody tests are commonly performed in hospitals to identify causes of immediate-type allergies. Recently, IgG tests for delayed-type hypersensitivity are also used to explore dietary connections, but both have limited test items and do not cover all foods.
Foods Not Detected by Tests and Easily Overlooked Items
Organ meats, some herbal teas, and certain processed foods may not be included in tests, making it easy to confuse acute hives caused by these with chronic symptoms. While home-based rapid kits can be a starting point, we recommend consulting a doctor or specialist for interpreting the results.
Pseudoallergens, Additives, Artificial Sweeteners, and Oxidized Oils: What to Watch Out For
What are Pseudoallergens? High-Histamine Foods and DAO Deficiency
Foods like cheese, fermented products, eggplant, spinach, and avocado are high in histamine. If you have a deficiency in diamine oxidase (DAO), the enzyme that breaks down histamine, these foods can trigger hive-like symptoms. Since this is difficult to detect with IgE or IgG tests, keeping a food diary and trying an elimination diet is a practical approach.
The Impact of Food Additives and Artificial Sweeteners
Additives such as benzoates, sulfites, colorings, and preservatives can be aggravating factors for sensitive individuals. There are also reports of artificial sweeteners like aspartame and sucralose affecting people's health, so it's worth temporarily stopping the consumption of processed foods and soft drinks to observe any changes. In a small group we tested, some experienced milder symptoms after reducing additives, though individual differences are significant.
The Risk of Oxidized and Degraded Oils
When oils oxidize, they produce harmful substances like lipid peroxides, acrylamide, and advanced glycation end products (AGEs), which can induce inflammation and allergic reactions. We recommend avoiding fried foods, repeatedly used oils, and prolonged high-temperature cooking. Instead, choose oils that are less prone to oxidation, such as olive oil or fresh rapeseed oil.
Don't Overlook Internal Factors, Infections, or Medications
H. pylori, Thyroid Disorders, and Chronic Infections
Reports indicate a link between H. pylori infection and hives, and it's known that thyroid autoimmunity (such as Hashimoto's disease) can coexist with chronic hives. We recommend confirming these through blood tests and H. pylori tests (breath test, blood, or stool antigen tests), and considering eradication or internal medical treatment if necessary.
Mast Cell Activation Syndrome and Medication Effects
If mast cell overactivity is suspected, or if certain medications like NSAIDs worsen symptoms, it's reassuring to consult a doctor to review medications and consider additional tests (such as blood tryptase levels).
Practical Countermeasures and When to See a Doctor
What You Can Do First: Record, Eliminate, and Review Your Environment
It's effective to record the days symptoms appeared, what you ate, cosmetics used, medications taken, stress levels, and sleep for 2-4 weeks. Then, try eliminating processed foods, additives, artificial sweeteners, fermented foods, and high-histamine foods for about 2-4 weeks and observe your progress. When we actually tried this, some people experienced reduced itching just by cutting back on processed foods. However, be careful not to be too extreme with elimination and pay attention to nutritional balance.
Key Consultation Points at Medical Institutions
If there's no improvement, symptoms are severe, or accompanied by difficulty breathing or facial swelling, immediate medical attention is necessary. A dermatologist or allergist will perform IgE/IgG tests, thyroid antibody tests, H. pylori tests, and possibly mast cell-related tests. While standard antihistamines are the basic treatment, if their effect is insufficient, increased dosages, other medications, or even biologics (such as omalizumab) may be chosen.
Summary
The causes of chronic hives are not singular, but multifaceted, including food (not just allergens but also pseudoallergens and additives), oxidized oils, artificial sweeteners, infections (H. pylori), thyroid autoimmunity, medications, physical stimuli, and mast cell issues. First, we recommend keeping a record to infer potential causes, and a simple trial of temporarily reducing processed foods, high-histamine foods, oxidized oils, additives, and artificial sweeteners is often effective. If there's no improvement or in severe cases, please collaborate with a specialist for further examination and treatment. Honestly, identifying the cause requires time and persistence, but gradually reviewing lifestyle habits can alleviate symptoms. We, the geefee team, will continue to share clues for improvement through information gathering and practical experience.
Disclaimer: The information in this article is for general informational purposes only and does not constitute medical advice. Please consult a qualified healthcare professional before making any health-related decisions.