Should You Follow a Low-Histamine Diet for Hives?

If you’re living with chronic hives — also called chronic spontaneous urticaria — you’re probably on a mission to find a solution. It’s understandable. You deserve a manageable plan for those itchy welts that seem to come and go as they please.

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You may have heard that a low-histamine diet could be the answer you’ve been searching for. But for most people, a diet change isn’t going to do the trick.

“There isn’t much of a connection between your diet and chronic spontaneous urticaria,” says allergist Dylan Timberlake, MD. “It’s definitely a question that allergists get asked a lot, but rarely are foods the driving factor.”

Dr. Timberlake explains why changing your diet isn’t likely to cure chronic urticaria, and what to do instead.

Should you follow a low-histamine diet for chronic hives?

A low-histamine diet is a medical diet for people with histamine intolerance. It limits foods that naturally contain histamine or contribute to your body releasing it. In other words, it’s an attempt to limit histamine in your body. That’s the chemical your immune system releases during an allergic reaction. It’s what causes classic allergy symptoms, like itching, swelling and redness.

People who follow a low-histamine diet for histamine intolerance are encouraged to eat whole, unprocessed foods and very ripe produce. They’re also advised to limit, among other things:

Additives, like colorants and preservatives
Aged cheeses
Processed or cured meats
Alcohol
Nuts
Certain fruits and vegetables

It’s not a leap to think that a low-histamine diet would help chronic hives. After all, hives are itchy and histamine can cause itching. So, eliminate histamine and you won’t itch anymore, right?

Not exactly.

“People tend to think that if they’re eating foods that are high in histamine, it can lead to hives,” Dr. Timberlake explains. “But a low-histamine diet is designed for people with histamine intolerance, which is different from chronic hives. Most people with chronic urticaria don’t have trouble digesting histamine from food.”

If you notice hives plus symptoms like throat tightness, trouble breathing, vomiting or dizziness after eating a specific food, that’s a different story. Those symptoms are more likely to point to a food allergy, not chronic urticaria. In this case, seek medical care right away.

Do certain foods cause chronic hives?

Chronic hives are rarely caused by food or allergies. And cutting certain foods out of your diet is a tall order, especially if there’s no clear reason to.

Research doesn’t strongly support restrictive diets for chronic hives. In one large review of studies, less than 5% of people who avoided certain foods had their hives resolve on their own.

“There was no significant benefit when people avoided those foods,” Dr. Timberlake reports.

And even if an elimination diet may seem to help at first, it’s probably not going to last.

“Unfortunately, what tends to happen is you take a food out of your diet and your hives happen to get better for a while,” he continues. “But then, your hives become worse. So, you start cutting out more and more foods, but with no real long-term relief.”

Over time, this can lead to unnecessary food restriction, stress and poor nutrition.

Better ways to manage chronic hives

The good news is that there are better ways to manage chronic hives. For starters, your provider may recommend avoiding or limiting common hives triggers, like:

Stress and anxiety
Heat, cold or pressure on your skin
Exercise
Infections
NSAIDs, like ibuprofen
Alcohol

Taking a daily, non-drowsy antihistamine (like Allegra^®, Zyrtec^® or Claritin^®) can also help. That’s not because your hives are caused by allergies, but because those medications can help relieve symptoms like itchiness.

If antihistamines aren’t enough, your provider may increase your dose or add other medications. Some people benefit from biologic treatments, too, which help calm overactive immune cells.

See an allergist or dermatologist if your hives:

Last longer than six weeks
Keep you up at night
Don’t improve with over-the-counter antihistamines

Remember, too, that chronic hives can affect your sleep, mood and quality of life, so don’t ignore the mental health impact. Ongoing itching and unpredictability can lead to anxiety or depression. If you’re struggling, talk with a provider about support options.

The bottom line: For most people, food doesn’t cause chronic hives. Instead of restricting your diet, work with a provider to find proper treatments and habits that’ll help you feel better.