Chronic Hives (Urticaria) – What is Urticaria?

Urticaria, commonly recognized as hives or chronic hives, is a result of a vascular skin reaction forming red or white welts that are often itchy in nature. The welts typically vary in size and can appear and fade repeatedly.  When hives occur for greater than 6 weeks or recur over an extended period, they are classified as Chronic Urticaria (CU) or chronic hives. These hives are not contagious or life-threatening, but they may be uncomfortable and interfere with daily activities, sleep, and eating if present around the mouth and/or lips.

Symptoms – How do I know if I have Chronic Urticaria?

Common signs and symptoms of chronic hives include:

  • Batches of red or white welts, usually on the face, trunk, arms or legs
  • Welts that vary in size, change shape and appear and fade repeatedly as the reaction runs its course
  • Itching
  • Swelling that causes pain or burning, especially inside the throat and around the eyes, cheeks, lips, hands, feet and genital region
  • Symptoms worsen in heat, exercise, and stress
  • Symptoms recur frequently and unpredictably, sometimes for months or years


Chronic hives are typically a sign of an underlying health problem. The following conditions may contribute to chronic hives.

  • Food allergies
  • Environmental allergies
  • Food sensitivities
  • Autoimmune conditions (thyroid disorder, lupus etc.)
  • Leaky Gut
  • Specific medications
  • Histamine intolerance
  • Mast cell disorders
  • Acute or chronic infection

Treatment – How Does Functional Medicine Treat Urticaria?

The first step is to identify the root cause, or the imbalances, that are triggering symptoms.  Collecting data is essential to determine the course of treatment. Possible tests or assessments your Functional Medicine doctor may order or conduct include.

  • Standard lab work to assess cardiometabolic, thyroid, inflammatory, and micronutrient markers
  • Food and environmental allergy testing (IgE mediated)
  • Food sensitivity testing (IgG, IgA, IgM mediated)
  • Stool sample and blood testing to identify potential pathogens or infections
  • Genetic testing for mast cell disorder
  • Dietary assessment to identify if foods or diet quality may be worsening symptoms

Treatment that may support improvements in chronic urticaria include

  • Removal of any identified environmental trigger
  • Removal of any identified food allergy or sensitivities
  • Implementation of a therapeutic diet protocol
    • Standard elimination diet
    • Low-histamine diet
    • Low-Salicylate/low-Tyramine diet
    • The FAILSAFE diet
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