Acute and Chronic Hives - Naturopathic Approaches

Hives happen when there is a skin reaction that causes red or white itchy welts. They might vary in size and come and go depending on how the reaction progresses.^[1] They are often circular or oval in shape. Urticaria is the medical term for hives and if hives happen chronically, then it’s often referred to as chronic urticaria. This usually indicates that the welts are lasting more than six weeks or that they are returning on a regular basis. In this article, we’ll refer to this set of skin reactions simply as urticaria. Acute cases of urticaria are more common than chronic urticaria, as they account for approximately 70% of cases.^[2] They are typically categorized as allergic reactions (called a type 1 hypersensitivity reaction). The translation is that this means there is an allergic trigger of some kind. This could be a pharmaceutical drug, a food or food group, or a bug bite. Sometimes the trigger can be identified and sometimes it remains a mystery. Even emotional or physical things can be triggers. Stress and anxiety can be triggers. Sweating from any cause (from exercise for example) can also be a trigger. Lastly, infections can trigger acute urticaria in some people (this could be bacteria, parasitic, or viral). So when so many possible causes exist, that’s when it becomes particularly difficult to isolate a specific trigger.

In chronic urticaria, the causes are often easier to identify because they are linked with chronic underlying health conditions. Autoimmune disorders are associated with chronic urticaria (conditions like SLE, thyroid disease, or Sjogren syndrome). These are usually identified through lab testing and there are numerous types of autoantibodies that can be identified. Cancer, typically of the gastrointestinal tract or lung cancer, are causes of chronic urticaria. Identification will depend on the specific type of underlying cancer. Endocrine abnormalities where hormone levels are elevated are another cause and can also be identified through direct lab measurements. Finally, if no other cause can be identified, the diagnosis is called chronic idiopathic urticara, which translates to hives that are recurrent and where doctors do not know the cause. It’s intended as a label to categorize the symptoms and it is considered a diagnosis of exclusion (which means it should not be used as a diagnosis until everything else has been ruled out). In this article, we’ll review the conventional medical treatments for urticaria and then we will review the naturopathic approaches that are available.

Conventional Care

First and foremost, if a trigger has been identified in acute urticaria, the trigger should be avoided (wherever reasonably possible). For example, if you know you are experiencing this allergic reaction to pineapple, then stop consuming pineapple. However, if you’ve identified exercise as a trigger, then it is not feasible to simply stop exercising. Instead, it makes more sense to try to narrow down the specific details. Does it happen while running? What about while jogging? Does it happen when heart rate hits a certain level? Does it happen if you are lifting weights or swimming? If there are types of exercise that are tolerable, you can modify your lifestyle by focusing on those types of exercise and minimizing the types of exercise that trigger you. Similarly with chronic urticaria, if an underlying condition has been diagnosed, then treatment should first focus on treating that condition. Autoimmune conditions are typically treated with various immune suppressants or steroids to help relieve inflammation. Cancer can be treated through pharmaceuticals or with chemotherapy. Endocrine problems can often be corrected with drugs or through hormone supplementation. For our purposes, we’ll focus on discussing approaches for treating chronic idiopathic urticaria, since it is the one condition where we can’t simply advise treating an underlying issue.

Nonspecific symptomatic treatments can include taking cool baths, avoiding hot water or warm environments, and wearing looser clothing. However, other than avoidance and underlying management, the mainstay of conventional treatment is antihistamines.^[2] They usually have to be taken on a regular basis. The only caution here is that many antihistamines cause drowsiness, so be cautious about the specific type you are taking. Antihistamines may not be effective for patients with chronic idiopathic urticaria. The other main treatment used is systemic corticosteroids. These are usually considered if the symptoms are severe, but they are not recommended long-term due to the risk of health complications.

Naturopathic Treatments

When it comes to supplements, there are several anti-inflammatories that have been used with success. Omega-3 fatty acids in the form of fish oil is a very commonly used treatment. It has two main components: EPA and DHA. Although both have anti-inflammatory activity, typically the EPA is considered more anti-inflammatory and more important in dermatological conditions. Doses of up to several grams are generally recommended. It can be prescribed in liquid form (the oil itself) or as a softgel.

Another very common anti-inflammatory is the flavonoid quercetin. Quercetin acts as both a natural anti-histamine and as an anti-inflammatory.^[3] In general, it blocks substances that are involved in allergic reactions (like mast cells). It is also very safe and can be used in conjunction with other treatments. Similarly, vitamin C can be used for this purpose. The dose is usually higher than what you might take as part of a multivitamin, so typically in the several gram range. Some practitioners will recommend even taking vitamin C to bowel tolerance, which means consuming it until you have diarrhea, then scaling that dose down so that no diarrhea is experienced. Another supplement that may be helpful from a systemic perspective is probiotics. Probiotics have effects on the immune system and can help regulate an over-active immune system. They must be kept in the fridge and taken with food to be most effective. Typically, multistrain preparations are suggested. These include many different types of bacteria that are known to be beneficial to humans in some capacity.

Acupuncture and Traditional Chinese Medicine (TCM) are commonly used to treat urticaria, particularly chronic idiopathic urticaria. In TCM, a specific assessment and diagnosis is made. The terms used here are very difficult to understand and appreciate from a Western medical perspective (words like heat, or dampness, or phlegm). A treatment is then created based on the underlying TCM assessment. Then either alone or in combination, herbs and acupuncture are used as treatment. So for example, if someone is assessed with having heat (which is a common way of categorizing urticaria), then the acupuncture points selected would be said to “clear heat”. A common set of points includes points on the arms and legs (LI11, SP10, ST36, SP6). Usually, once a protocol is determined, acupuncture needles are inserted for 30 minutes during a treatment session. Treatments would be recommended once to twice a week for 6 weeks before a reassessment should be made.^[4]

Herbal medicine can also be used. It can be individualized to the case, or a mix of herbs that have various actions can be combined. Anti-inflammatory herbs can be helpful. Herbs that have activity on the liver are called hepatics, and these may help reduce skin irritation. Examples include dandelion, burdock, and milk thistle. Herbs can also be used in lotion form (chamomile, lavender, aloe vera, calendula). These are called vulneraries and they help with healing and repair. Herbs that help regulate the immune system are called immunoregulatory, and these include herbs like astragalus, echinacea, red clover, or andrographis. They can dampen an over-sensitive or over-reactive immune system, as is seen in urticaria.

Conclusion

Urticaria, both acute and chronic, have a handful of possible triggers and causes. It is important to try to narrow down the cause as much as possible, as that will then help determine what the most beneficial treatment will be. There are lifestyle modifications that can help treat symptoms in most cases, including the avoidance of heat and the use of loose clothing or soothing creams. Conventional treatments rely on antihistamines and steroids. Naturopathic treatments provide many different options, including supplements, acupuncture, and herbal medicine. Each of these has their pros and cons, as well as their associated costs. However, the best treatment is usually a combination of the above based on an individualized and complete case history. Overall, we recommend you see your Naturopathic Doctor to help you with assessment and with a treatment that is right for you.