Chronic Hives and Diet: The Debate Over What To Eat

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What we eat has a huge impact on our health, but the best choices to make aren’t always obvious, especially when dealing with a difficult condition like chronic hives. Many people with chronic hives (also known as chronic urticaria) identify different foods as possible triggers of their symptoms and make dietary decisions without enough information. In the following slides, we’ll explore some of the facts, myths, and up-for-debate information about food and chronic hives.


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Food is considered a possible trigger for hives

When it comes to hives, food is often listed among the common triggers for patients to be aware of. People with either chronic or acute cases of hives are often asked to keep track of their hives symptoms and note foods they consume before their symptoms started. If a food is suspected, allergy testing may be done. Other common triggers are medications, insect bites/stings, latex, infections, or other allergens people come in contact with.


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Fact or myth? The connection between food and chronic hives is highly debated

For chronic idiopathic hives (or hives where a cause can’t be determined) doctors and researchers often debate if food and diet have an effect. Some studies have found that food isn’t a common trigger and diet isn’t relevant in cases of chronic hives. Other studies argue for the importance of taking a closer look at how food is involved in cases where another cause can’t be found.


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Many hives patients believe certain foods are triggers and avoid eating them

Regardless of differing viewpoints by researchers, both sides have noted that patients with chronic hives often believe that their skin condition is at least aggravated by certain foods. Many people avoid foods they suspect of causing hives. These avoidance diets can affect their overall health if they aren’t getting proper nutrition, as well as their personal and social lives.


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Can a low histamine diet decrease chronic hives symptoms?

Some studies have found that patients who eat a low-histamine diet report decreased symptoms and improved quality of life. Histamine is a chemical released from mast cells in the body as part of an allergic response. In one study, patients showed significant improvement in their symptoms and decreasing levels of histamine in their blood after being on a histamine-free diet for four weeks.


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Up for debate: The role of histamines and histamine intolerance in chronic hives

Although studies noted that less than 2 percent of chronic hives cases have a food allergy, some chronic hives patients are believed to have a histamine intolerance, which may be a trigger for their unexplained hives. A histamine intolerance mimics reactions similar to a food allergy, and may cause a hives reaction, but it’s unclear how common these reactions are among chronic hives patients.


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The difference between food allergy and histamine intolerance

A person with a food allergy has an immediate reaction after eating the food. Skin and blood tests will confirm the allergy. People with a histamine intolerance have these chemicals build in their system over time. Once histamines reach a certain threshold, it can cause an allergic-type reaction, like hives. It’s likely the person will test negative for a food allergy. Because of this, histamine intolerance is considered a “pseudoallergy.”


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Can a low-histamine diet help reduce chronic hives?

Based on the theory that some people with chronic hives have a histamine intolerance, researchers have examined the effect of low histamine/low pseudoallergy diets. One study, which looked at 56 patients who followed a low-histamine diet for three weeks, found that 75 percent of patients showed improved symptoms for their chronic hives. That study also concluded that a low-histamine diet followed for three to four weeks may help reduce symptoms and improve quality of life for people suffering from chronic hives.


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A low histamine diet limits food options

Foods that are typically avoided are known to be high in histamines or can cause a histamine response. These may include citrus fruit; spinach, eggplant, tomatoes, artichokes, and avocado; aged cheeses and fermented foods, such as gouda and sauerkraut; processed meats like sausage and salami; shrimp and processed fish including sardines, tuna, and herring. Also, egg whites and most alcoholic beverages (especially red wine) are high in histamines.


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Up for debate: Are diet restrictions ineffective?

Avoiding foods high in histamines if a person doesn’t have food allergies is considered controversial. It’s ineffective and puts unnecessary restrictions on a person’s diet, some studies say. One study found that in 95 percent of patients with self-reported food reactions, the food they were eating wasn’t related to the onset of their symptoms.  Still, the study found that more than 80 percent of these patients were carrying out unnecessary dietary restrictions that might be detrimental to their health.


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Are pseudo allergies a myth?

Some doctors believe there is no connection between chronic hives and histamine intolerances, and have even called pseudoallergies a myth, saying that there isn’t enough support in these studies to prove such diets work. Other studies indicate that a low-histamine diet is an easy, low-cost tool to decrease symptoms and increase quality of life for chronic hives patients.


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Should people with chronic hives limit their diets?

There is no easy answer to the question about what diet is best for people with chronic hives. In fact, this debate is one of the most contentious disagreements between the US and international medical guidelines on chronic hives.


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An international debate

As part of its guidelines on managing hives, the American Academy of Allergy, Asthma, and Immunology doesn’t recommend low-histamine (or pseudoallergen-free) diets because it says studies looking at this issue weren’t well controlled and didn’t meet stringent research standards. However, international guidelines acknowledge “pseudo allergen-free” diets as an alternative treatment that may help some chronic hives patients.


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Doctors in different regions of the world have differing views on low-chemical diets

The World Allergy Organization has also noted that that doctors in different areas of the world have widely differing views when it comes to low-histamine diets for chronic hives. While many U.S. doctors see low-histamine diets as having limited success, some doctors in Europe and elsewhere recommend such diets be followed and then gradually expanded.