Thyroid Linked to Chronic Hives, Autoimmune Urticaria

hives, urticaria, chronic hives, thyroid, hypothyroidism, autoimmune, autoimmunity
Chronic hives are frequently linked to an underlying thyroid dysfunction. istockphoto

Urticaria is the medical term for hives. Hives -- also referred to as wheals -- are circular lesions or welts that can develop quickly on the skin, most often on the face, torso, arms or legs. Hives range in size from a small spot to many inches in diameter.

One can develop a single hive, or have an outbreak of numerous hives. Typically, hives are itchy. Hives develop due to the release of histamine into the skin, triggering an allergic response.

(See pictures of hives here.)

Chronic urticaria is defined as developing hives on a daily basis for at least six or more weeks or hives that recur over months or years.

In some cases, chronic urticaria can be tracked to a particular food allergy, such as nuts, peanuts, fish, wheat, eggs, or dairy products. In other cases, environmental allergens, like pollen can be a trigger. For some people, insect bites can trigger hives. But the majority of cases have no clear cause, and are referred to as chronic idiopathic urticaria -- with "idiopathic" meaning that the trigger is unknown. In those cases, it's now assumed that at least of the cases of chronic idiopathic urticaria are autoimmune in origin.

Chronic Hives and Urticaria Related to Thyroid, Autoimmune Disease

The most common autoimmune condition in people with chronic urticaria is thyroid disease. In some studies, as many as 10 to 50 percent of chronic urticaria patients have underlying autoimmune thyroid disease - most commonly Hashimoto's disease and hypothyroidism.

The urticaria tends to be more severe in those patients with autoimmune thyroid disease.

Antithyroid antibodies are also far more common in chronic urticaria patients, versus the general population. The combination of chronic urticaria and hypothyroidism is more common in women than men.

There are other autoimmune diseases that are more frequently linked to chronic urticaria.

They include:

Treating Thyroid Disease to Resolve Chronic Urticaria / Hives

Research shows that some chronic urticaria patients who are hypothyroid or who have elevated antibodies may have a remission of chronic urticaria with appropriate thyroid treatment.

In one study, 70 percent of patients who had normal TSH levels, but elevated antibodies, had remission of their chronic urticaria when treated with levothyroxine. All the patients relapsed, and their urticaria returned, when therapy was stopped.

IMPORTANT ACTION POINT: If you have chronic urticaria, but have not have a thorough thyroid screening, this should be done as soon as possible to diagnose or rule out underlying thyroid disease. Make sure that your thyroid screening includes both thyroid peroxidase antibodies (TPO) and thyroglobulin antibodies (TgAb).Treating any thyroid irregularities may resolve your chronic urticaria without need for other treatment.


Treatments for Chronic Urticaria / Hives

In addition to identifying and treating any underlying thyroid issues, there are a number of treatments for chronic hives.


The primary treatment for chronic urticaria is antihistamine drugs -- specifically those that don't cause drowsiness, such as Cetirizine (i.e., Zyrtec), levocetirizine (i.e., Xyzal), desloratadine (i.e., Clarinex), loratadine (i.e., Claritin, Alavert), and fexofenadine (i.e., Allegra) - to reduce the allergic response.

After several weeks, if this approach is not effective, increased doses of antihistamines are typically recommended, or use of drowsiness-inducing antihistamines --Hydroxyzine (i.e., Vistaril), Diphenhydramine (i.e., Benadryl), or Chlorpheniramine (i.e., Chlor-Trimeton) -- may be recommended.

Leukotriene Antagonists

About half of chronic urticaria patients do not have symptom relief with even increased dose of antihistamines, and treatment is typically a change of antihistamine type, and/or addition of a drug known as a leukotriene antagonist. Common leukotriene antagonists include: montelukast (i.e., Singulair), zafirlukast (i.e., Accolate), Pranlukast (i.e., Onon), and Zileuton (i.e., ZYFLO).

Corticosteroid Drugs

Some patients respond to a short course of three to seven days of a systemic oral steroids drug, such as prednisone, in addition to the antihistamines and leukotriene antagonists.

Other Drug Treatments

Other treatments that are used, if these other options are not effective, include the immunosuppressant drug cyclosporine A (i.e., Neoral and Sandimmune), and acid-reducing drugs known as H2 blockers -- i.e., cimetidine (i.e., Tagamet), famotidine (i.e., Pepcid), nizatidine (i.e., Axid) and ranitidine (i.e., Zantac).

The drug dapsone, also known as diaminodiphenyl sulfone (DDS), is an antibiotic that can be effective for some patients. Finally, an asthma drug omalizumab (Xolair), a humanized monoclonal antibody, has had good results with chronic urticaria patients who did not respond to other treatments.

It's controversial, but some experts believe that one cause of chronic urticaria is infection with the Helicobacter pylori -- or H. pylori -- bacteria. This is the same bacteria that has been found to cause some stomach ulcers. Researchers discovered that the antibiotics given to the ulcer patients to rid them of the H. Pylori also cleared up chronic urticaria in some of these patients.

Things to Watch for With Chronic Urticaria / Hives

Some patients with chronic urticaria have a tendency for their symptoms to flare with common triggers, including heat, cold, sun exposure, exercise, sweating, water exposure, stress, and alcohol. Learn your triggers, so that you can avoid them.

Some research has shown that taking a nonsteroidal anti-inflammatory drug (NASD) aggravates chronic urticaria symptoms in as many as 20 percent of patients. The same effect is not seen with COX-2 inhibitors, and so some experts recommend that chronic urticaria patients who need to control inflammation use a COX-2 inhibitor versus general NSAIDs. A common COX-2 inhibitor is celecoxib (i.e., Celebrex).

IMPORTANT NOTE: If at any time, you develop hives in your mouth, nose, or throat, and/or are having trouble breathing, or feel your tongue or throat swelling, seek emergency care immediately.


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