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Living with chronic hives can be frustrating and unpredictable. It’s natural to wonder whether other health conditions could be related. Chronic hives don’t always have a clear cause, but research shows they often occur alongside other medical conditions.
Researchers have found links between chronic hives and other diseases. In fact, 1 in 5 people who have chronic hives also have an autoimmune condition — a condition where the immune system makes a mistake and starts attacking healthy organs in the body.
One type of chronic hives, chronic spontaneous urticaria (also called CSU or chronic idiopathic urticaria), has no known underlying cause. Even so, people with CSU may be more likely to have other conditions at the same time.
Although researchers continue to find connections between chronic hives and several health conditions, the list below highlights some of the most well-established associations and is not exhaustive. Here are seven conditions commonly linked to chronic hives, as well as what symptoms you should look out for.
Rheumatoid arthritis (RA) is an autoimmune disease where a person’s immune system attacks their joints. RA causes increased inflammation all over the body. This is because mast cells — specialized immune cells that make inflammatory molecules — aren’t working properly. Defective mast cells release a molecule called histamine. Histamine makes the body have an allergic reaction.
This is related to the symptoms of RA flare-ups, such as:
The release of histamine can also cause chronic hives. Researchers have found a genetic link between rheumatoid arthritis and chronic hives. This means people with RA are more likely than others to also have chronic hives.
Lupus is an autoimmune disease where a person’s immune system mistakenly attacks many of its own tissues and organs. Affected tissues can include the skin, blood cells, brain, kidneys, heart, and lungs.
Over 5 million people in the world are affected by lupus. The symptoms of lupus vary and can seem similar to other diseases. This makes the diagnosis process challenging for many people. The symptoms of lupus typically include:
There’s a link between lupus and chronic hives. In fact, up to 21 percent of adults with systemic lupus erythematosus, the most common form of lupus, also have chronic hives. Autoimmune diseases like lupus create an increased inflammatory state in the body, which can affect the skin and may lead to chronic hives.
Autoimmune thyroid disease (which includes Hashimoto’s thyroiditis and Graves’ disease) is an autoimmune disease where the immune system mistakenly attacks the cells in the thyroid gland. The thyroid is an organ that sits at the base of the neck, and its job is to produce hormones that help regulate several systems in the body.
In Hashimoto’s thyroiditis, which is more commonly associated with CSU than Graves’ disease, the immune system destroys the thyroid. As a result, the hormones it usually makes are no longer produced. This can lead to symptoms like:
One study found that between 25 percent and 30 percent of people with chronic hives were also diagnosed with Hashimoto’s thyroiditis. The exact relationship between the diseases is unknown. However, both diseases are linked to high levels of a molecule called interleukin-6, a protein that sends signals that cause inflammation in the body. They are also associated with a low activity of regulatory T cells that help reduce inflammation in the body.
Vitiligo is an autoimmune disease where the immune system mistakenly attacks melanocytes — the cells that give skin its pigmentation (coloring). This causes the skin to lose its pigment. Often, loss of skin pigment begins on the hands, feet, forearms, or face, but it can spread over time. In addition to losing pigment in the skin, symptoms of vitiligo include loss of pigment in patches of hair (certain areas will turn silver, gray, or white). Sometimes, the skin will itch.
Vitiligo is one of the most common conditions linked to chronic hives. Over 3 percent of people with chronic hives also have vitiligo. Immune system antibodies (proteins) linked to vitiligo may also play a role in releasing histamine, one of the key causes of chronic hives.
Celiac disease is an autoimmune disease where the immune system mistakes gluten as a threat, creating inflammation in the small intestine. Gluten is a protein found in wheat, rye, and barley. Intestinal inflammation from eating foods with gluten can prevent nutrients from being absorbed and cause symptoms like:
People living with celiac disease often have increased numbers of mast cells, which produce histamine. Histamine can be responsible for triggering chronic hives. People who have celiac disease are more likely to have other autoimmune conditions.
Type 1 diabetes is an autoimmune disease where the immune system attacks the cells in the pancreas that make insulin. This causes the pancreas to make little or no insulin. Insulin is an important hormone that helps bring sugar into cells to make energy. Without energy, cells can die.
This cellular damage, combined with the toxicity of sustained high blood glucose levels, causes damage to the heart and blood vessels, kidneys, nervous system, eyes, and skin. Common symptoms of type 1 diabetes include:
A 2019 study found that children with type 1 diabetes are 3.62 times more likely to develop chronic hives than those who don’t have type 1 diabetes. One possible reason for this is that changes in blood sugar associated with diabetes might trigger mast cells to release histamine in the skin and cause chronic hives. The study did not find that adults with type 1 diabetes had the same risk for hives.
Some infections, especially an infection with bacteria called Helicobacter pylori (H. pylori), are linked with chronic hives. H. pylori causes a common stomach infection. Over 43 percent of all people worldwide have an H. pylori infection. Symptoms are often associated with the gastrointestinal (GI) tract and include:
H. pylori infections are often associated with living in crowded conditions, drinking unclean water, and sharing food or utensils.
One 2021 study found that between 16 percent and 18 percent of people in China with chronic hives also had an H. pylori infection. One reason that might explain this connection is that H. pylori makes the stomach lining leaky. This can allow allergens into the digestive tract. The immune response to these allergens, or to H. pylori itself, can encourage mast cells to release histamine in the skin, which causes chronic hives.
If you suspect your chronic hives might be related to any of these conditions, talk to a dermatology (skin disease) specialist or healthcare provider about treatment options.
On MyChronicHivesTeam, people share their experiences with chronic hives, get advice, and find support from others who understand.
If you live with chronic hives, do you have any additional health conditions? Let others know in the comments below.
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My husband had chronic hives for over ten years. Test after test no answer. Finally we figured out it might be alpha-gal he asked to be tested and was positive with high numbers. Since the diagnosis… read more
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