Autoimmune Disease Causing Hives: Diagnosis & Management

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Understanding Hives and Chronic Hives

Hives Defined

Hives, or urticaria, are a common skin reaction. They present as red, itchy welts on the skin’s surface, often diagnosed in dermatology as physical urticaria, idiopathic hives, or urticarial vasculitis. Acute hives, a physical urticaria presenting as skin reactions, last less than six weeks, often triggered by allergies to food or medication, and may respond well to H1 antihistamines or antihistamine therapy. Chronic hives, a skin disorder known as physical urticaria, persist beyond six weeks, with causes harder to identify, often involving skin reactions poorly responsive to H1 antihistamines.

Chronic cases may not have an obvious trigger. This unpredictability adds stress for those affected. The connection between autoimmune disorders, characterized by autoallergy and the presence of ige autoantibodies/autoantibody, and chronic hives involving the high affinity ige receptor is noteworthy. In some individuals, the body’s immune system, through a process known as autoallergy, attacks its own tissues with autoantibodies, mistaking them for harmful pathogens, a phenomenon central to the pathogenesis of this condition.

Acute vs Chronic

Acute hives are temporary. They often result from clear triggers like certain foods or medications, involving mechanisms such as histamine release, autoallergy, and autoantibodies. These reactions, often involving autoallergy mechanisms such as histamine release by mast cells, are typically manageable once the allergen is identified and avoided.

Chronic hives differ significantly. They last longer than six weeks and frequently lack an identifiable cause, often involving complex mechanisms including pathogenesis, disease progression, and autoantibodies. This type is known as idiopathic hives. It challenges patients and doctors alike due to its elusive nature, with the disease’s pathogenesis often remaining obscure even in the presence of extensive studies on the subjects.

Common Triggers

Several factors can trigger acute hives:

  • Allergic reactions to foods or drugs
  • Infections
  • Stress
  • Physical stimuli such as cold or pressure

For chronic hives, triggers are less clear. Studies in Clin Exp Allergy suggest a link with autoimmune responses, where the body’s immune system mistakenly targets its own cells, involving autoantibodies in the pathogenesis of the disease through mechanisms.

Impact on Life Quality

Living with chronic hives severely affects quality of life. Its unpredictable flare-ups can cause discomfort and embarrassment.

Patients report significant emotional stress due to the persistent nature of their condition. The search for effective treatment for disease becomes a constant struggle, often involving trial and error with different medications, as the pathogenesis is studied through sources like Google Scholar.

Autoimmune Diseases and Hives Connection

Immune System Error

The immune system, designed to protect us, sometimes errs. It mistakenly targets healthy cells, causing autoimmune diseases. When this misdirection, a disease involving autoantibodies targeting mast cells causing their degranulation, involves the skin, it can lead to chronic hives.

Autoimmune disorders disrupt normal immune functions. They prompt the body to produce autoantibodies. These autoantibodies target the body’s own tissues, including mast cells, instead of foreign pathogens, causing disease in the subjects. In the context of hives, autoantibodies against IgE receptors or skin mast cells, often found in subjects’ serum, are culprits, leading to basophils and mast cells degranulation. This misguided attack, involving autoantibodies and mast cells, triggers inflammation through degranulation and the characteristic welts of hives, a symptom of the disease.

Autoantibody Mechanisms

Autoantibodies play a key role in linking autoimmune diseases to hives, involving mast cells and basophils, according to a PubMed abstract on subjects. Specifically, IgE autoantibodies bind to high affinity IgE receptors on mast cells and basophils, leading to their activation and degranulation in subjects according to a PubMed abstract. This binding initiates a cascade of events leading to the activation of mast cells and basophils, resulting in the release of histamine, autoantibodies, and other inflammatory substances. These substances cause swelling, redness, and itchiness associated with hives, a disease where mast cells release autoantibodies affecting subjects.

Moreover, the presence of free IgE not bound by autoantibodies can exacerbate this reaction, particularly in subjects with disease, where activation of mast cells is involved. It further increases sensitivity to allergens and irritants. This heightened sensitivity, often linked to autoantibodies targeting mast cells, can make managing the disease of hives more challenging in subjects with autoimmune conditions.

Common Autoimmune Links

Several autoimmune diseases are frequently associated with chronic hives. Thyroid autoimmunity is a notable example. Conditions like Hashimoto’s thyroiditis, involving autoantibodies and IgE, can trigger hives in affected subjects by activating mast cells.

Lupus is another autoimmune disorder linked to chronic hives. The systemic nature of lupus, involving autoantibodies and mast cells, means it can affect multiple organs and tissues, including the skin, as et al. and ige indicate. Rheumatoid arthritis and celiac disease also have connections to chronic urticaria through similar mechanisms involving IgG antibodies, IgE, mast cells, and immune system dysregulation, as detailed in Google Scholar and PubMed abstracts.

The link between autoimmune disorders, where antibodies attack cells, and chronic hives underscores the importance of a comprehensive approach to diagnosis and treatment, as highlighted in the Pubmed abstract with its DOI. Understanding these connections, including antibodies, cells, and IgE as indicated in the PubMed abstract, helps tailor treatments that address both the symptoms of hives and the underlying autoimmune condition.

Symptoms Differentiating Autoimmune Hives

Persistence Indicator

Autoimmune hives often persist for longer durations than those caused by allergies or physical factors. A key symptom, as noted in a Pubmed abstract and supported by DOI research, that suggests hives might be autoimmune-related is their persistence beyond six weeks without an identifiable external trigger, involving IgE and cells. This extended duration can be frustrating and confusing for sufferers, as the usual suspects like food, medication, or environmental allergens do not apply.

They may appear suddenly and last for a few days or weeks before disappearing, only to reoccur. This cycle can be exhausting both physically and emotionally for individuals.

Associated Symptoms

Another indicator of autoimmune hives is the presence of other symptoms commonly associated with autoimmune diseases. These can include joint pain, fatigue, and sometimes fever. The occurrence of these additional symptoms alongside hives can signal an underlying autoimmune condition.

Joint pain often manifests as a dull ache or a sharp pain in one or more joints, sometimes accompanied by stiffness. Fatigue linked to autoimmune diseases is not just regular tiredness; it’s a profound exhaustion that doesn’t improve with rest.

Pattern Recognition

Noticing patterns or triggers that exacerbate hives can also aid in distinguishing autoimmune hives from other types. While physical urticaria (hives caused by direct physical stimulation of the skin) has clear triggers such as pressure, cold, or heat, autoimmune hives may flare up without any apparent reason. However, some patients report stress as a significant factor in triggering their symptoms.

Identifying these patterns requires careful observation and possibly keeping a diary of hive occurrences and potential triggers. This information, including IgE levels and accessible through PubMed abstracts, DOI references, and Google Scholar, can be invaluable to healthcare providers in diagnosing and treating autoimmune-related hives effectively.

Importance of Early Diagnosis

Early Benefits

For many patients, the journey toward understanding and managing autoimmune diseases causing hives begins with an early diagnosis. This crucial step can significantly impact disease severity and the patient’s overall health. An early diagnosis enables healthcare providers at medical centers to tailor treatments that reduce disease activity, preventing severe outbreaks. It also opens the door to exploring lifestyle changes and medications that can offer relief and improve quality of life.

Early intervention can halt the progression of the disease, making it easier to manage symptoms. Patients benefit from a comprehensive approach that addresses not only the physical manifestations but also the emotional toll such conditions can take.

Diagnostic Challenges

The pathogenesis of autoimmune diseases that cause hives, often mediated by IgE and complex, is frequently overlapping with symptoms of other health conditions, as detailed in PubMed abstracts and DOI-linked Google Scholar articles. This overlap presents significant challenges in achieving an accurate diagnosis, often requiring consultation of full text articles, doi references, and google scholar searches for ige-related studies. Many patients experience frustration as they undergo various tests, including doi and ige assessments, that may not immediately pinpoint autoimmune hives as the cause, according to google scholar full text.

Healthcare professionals must consider a wide range of possibilities, requiring time and patience from both parties. The presence of other autoimmune disorders or triggers can further complicate the diagnostic process, underscoring the importance of thorough medical evaluation.

Role of Patient History

A detailed patient history plays a pivotal role in aiding early diagnosis efforts. Patients are encouraged to track their symptoms over time, noting any patterns or triggers that may be relevant. This information, sourced from Google Scholar and including IgE levels, becomes invaluable when healthcare providers try to differentiate autoimmune hives from similar conditions discussed in the previous section on “Symptoms Differentiating Autoimmune Hives.”

Women, in particular, may notice fluctuations in disease activity related to hormonal changes, highlighting the need for gender-specific considerations in treatment planning. The interest in understanding these nuances, underscored by Ige et al., highlights the complexity of diagnosing and managing autoimmune diseases.

Diagnostic Tests Overview

Blood Tests

Blood tests, including IgE levels, et al, are a key screening tool for identifying autoimmune diseases causing hives. They detect antibodies that the body may produce in response to an autoimmune disorder. Specifically, doctors look for elevated levels of antinuclear antibodies (ANA), which suggest an autoimmune reaction.

These tests can help rule out other conditions with similar symptoms. However, a positive result doesn’t always confirm the presence of an autoimmune disease. It may require further investigation through more specific tests.

Skin Biopsy

A skin biopsy involves taking a small sample of skin from the affected area. This test is crucial for examining the tissue under a microscope. Pathologists look for signs of inflammation, ige, or other changes indicative of an autoimmune response.

This procedure, involving IgE levels, helps distinguish between autoimmune hives and other skin disorders. Though informative, it’s invasive and may not be the first choice for every patient.

Allergy Testing

Allergy testing, including IgE levels, is another important step in diagnosing autoimmune hives. By exposing the skin to various allergens and observing reactions, doctors can identify potential IgE triggers. This test aims to rule out IgE-mediated allergic reactions as the cause of hives.

While useful, allergy tests (including IgE levels) alone cannot confirm an autoimmune condition. They serve more as a process of elimination, helping narrow down the list of possible causes.

Limitations and Next Steps

No single test can definitively diagnose autoimmune hives. Often, doctors must perform multiple tests to gather enough evidence for a diagnosis. Each test has its limitations and may not provide clear answers on its own.

Patients might undergo a series of blood tests, including IgE levels, skin biopsies, and allergy screenings before reaching a conclusive diagnosis. This systematic approach ensures that other potential causes are ruled out and that the treatment plan addresses the underlying autoimmune issue.

Basophil Histamine Release Assay

Test Overview

Basophils, through their interaction with IgE, play a key role in allergic reactions, including autoimmune hives. The basophil histamine release assay, which measures IgE-mediated histamine release, quantifies how much histamine these cells release. Doctors use this IgE test to diagnose autoimmune diseases causing hives.

Histamine, triggered by IgE, is a chemical that can cause swelling, redness, and itching. When basophils and mast cells degranulate, they release histamine. This process is crucial for understanding autoimmune hives.


This assay stands out because it specifically identifies autoimmune responses. It differentiates these from other causes of hives by measuring the reaction of donor basophils to specific triggers, including IgE.

Most tests check for general allergies. However, the basophil histamine release assay, which also measures IgE levels, looks for signs of mast cell activation unique to autoimmune disorders. This specificity makes it a valuable tool for doctors.


Undergoing a histamine release assay involves several steps. First, healthcare professionals collect a blood sample. They then isolate the basophils from other blood components.

In the lab, technicians expose these basophils to allergens or autoantibodies, including IgE, suspected of triggering hives. They measure how much histamine the basophils release in response to IgE.

The amount of released histamine and IgE indicates whether an autoimmune response is causing the hives. High IgE levels suggest that mast cell degranulation is part of the problem.


Not all medical facilities offer this sophisticated test due to its complexity and the need for specialized equipment. Patients might need to visit specialized allergy or immunology centers to undergo it.

Despite its limited availability, those suffering from chronic or unexplained hives may find it worthwhile to seek out this test. It can provide clear answers where other tests might not.

By providing detailed insights into how one’s body reacts at a cellular level, the basophil histamine release assay offers hope for better understanding and managing autoimmune-induced hives.

  • It pinpoints specific immune responses.
  • The test helps differentiate between autoimmune and non-autoimmune causes of hives.
  • Though not widely available, its benefits make seeking it out worthwhile for many patients.

Autologous Serum Skin Test

Test Method

The autologous serum skin test involves a simple yet effective procedure. Here, a small volume of the patient’s own blood is drawn and centrifuged to separate the serum. This serum, rich in potential autoantibodies, is then injected back into the skin, typically in the forearm, through an intradermal injection.

Patients might feel slight discomfort during the process, but it’s generally well-tolerated. The site of injection is observed for reactions, which could indicate the presence of autoantibodies causing skin disorders.

Autoantibodies Detection

This test shines a light on autoantibodies, such as thyroid antibodies or thyroid peroxidase, that play a role in autoimmune hives. By reintroducing the patient’s own serum into their system, doctors can observe direct skin reactions. These reactions are pivotal in understanding how one’s immune system might be attacking its own cells, leading to chronic hives.

Research shows that individuals with positive test results often have higher levels of these autoantibodies. It underscores the body’s hypersensitivity to certain proteins or antigens found within one’s blood.

Implications for Treatment

A positive autologous serum skin test result can significantly alter treatment paths for those suffering from chronic autoimmune hives. It not only confirms the autoimmune nature of the condition but also helps in tailoring more specific treatments.

For instance, therapies like cyclosporine have shown promising results in managing symptoms in patients with confirmed autoimmune hives through this test. Understanding that one’s condition has an autoimmune basis opens doors to more targeted approaches rather than general antihistamine treatments.

Moreover, detecting thyroid autoantibodies can prompt further investigation into one’s thyroid health, as there’s often a link between thyroid issues and chronic urticaria (hives).

General Management Strategies

Lifestyle Changes

People with autoimmune diseases causing hives can benefit from lifestyle adjustments. Stress management plays a crucial role in controlling outbreaks. Techniques such as meditation, yoga, and regular exercise can help reduce stress levels, potentially minimizing the frequency of hives.

Avoiding known triggers is another key strategy. Since each individual may react differently to various substances or conditions, it’s vital to identify and steer clear of these factors. Common triggers include certain foods, medications, and environmental factors like extreme temperatures.

Dietary Recommendations

Diet also has a significant impact on the management of autoimmune diseases that cause hives. Incorporating anti-inflammatory foods into one’s diet can support overall health and possibly reduce symptom severity. Foods rich in omega-3 fatty acids, like salmon and flaxseeds, are beneficial. Conversely, processed foods and those high in sugar should be limited.

Hydration is another critical factor. Drinking plenty of water helps flush out toxins that could exacerbate symptoms.

Regular Monitoring

Tracking symptoms over time is essential for identifying patterns or specific triggers related to hives outbreaks. This process involves noting down daily activities, diet, stress levels, and any new products used. Over time, this log can reveal insights into what might be contributing to flare-ups.

Regular monitoring also includes staying vigilant about any new symptoms or changes in condition. This proactive approach allows for timely adjustments in management strategies.

Multidisciplinary Approach

A comprehensive management plan often involves a team of specialists. Allergists and immunologists play a pivotal role in diagnosing triggers and prescribing treatments tailored to individual needs.

Collaboration with nutritionists can provide guidance on dietary changes that support immune system health. Mental health professionals may offer strategies for coping with the emotional aspects of living with an autoimmune disease.

Treatment Options for Autoimmune Hives


Antihistamines stand as a cornerstone in managing autoimmune hives. These medications work by blocking the effects of histamine, a substance in the body that can cause itching, swelling, and redness. Oral antihistamines are often the first line of treatment. They can significantly reduce symptoms for many patients.

Doctors might prescribe a higher dose than what is typically used for seasonal allergies. This approach helps control symptoms more effectively. Patients usually start seeing improvements within days of starting antihistamine therapy.


For more severe cases, corticosteroids may be introduced. These potent anti-inflammatory drugs can quickly reduce swelling and discomfort associated with autoimmune hives. However, due to potential side effects, their use is generally limited to short-term management during flare-ups.

Corticosteroids are not a long-term solution. Their effectiveness comes at the cost of possible impacts on bone density, blood sugar levels, and immune function.


Immunosuppressants offer another avenue for treatment when standard therapies do not suffice. By dampening the immune system’s activity, these drugs can help manage chronic autoimmune hives. Yet, they require careful monitoring due to risks like increased susceptibility to infections.

Patients must undergo regular check-ups to ensure their safety while on immunosuppressants. This ensures that any adverse effects are caught early and managed promptly.

Biologic Therapies

Recent advances have introduced biologic therapies targeting specific pathways involved in the immune response to hives. These treatments represent a significant leap forward in autoimmune hive management.

Biologics are designed for individuals whose condition does not respond well to other treatments. They focus on precise mechanisms within the immune system, offering hope for those struggling with persistent symptoms.

Personalized Plans

Treatment plans must be tailored to each patient’s needs. Factors such as symptom severity, previous treatment responses, and personal preferences play critical roles in crafting an effective strategy.

A personalized approach ensures that each individual receives the most appropriate and effective treatment regimen. It highlights the importance of ongoing communication between patients and healthcare providers.

Closing Thoughts

Navigating the world of autoimmune diseases and hives can be daunting, but understanding the connection, recognizing symptoms, and knowing your diagnostic and treatment options empowers you to take control. Early diagnosis and tailored management strategies are key to improving your quality of life. Remember, you’re not alone in this journey. With the right knowledge and support, living with autoimmune hives becomes a manageable part of your story, not the entirety of it.

Don’t hesitate to reach out for professional advice if you suspect autoimmune hives. Taking action now can make all the difference. Let’s prioritize your health together. Stay informed, stay proactive, and let’s tackle autoimmune hives head-on for a happier, healthier you.

Frequently Asked Questions

What is the connection between autoimmune diseases and hives?

Autoimmune diseases can trigger chronic hives by causing the immune system to attack the body’s own tissues, leading to inflammation and the appearance of hives.

How can you tell if your hives are caused by an autoimmune disease?

Symptoms indicating autoimmune hives include chronic outbreaks lasting more than six weeks, hives accompanied by pain or swelling deeper in the skin, and not responding well to typical antihistamines.

Why is early diagnosis of autoimmune hives important?

Early diagnosis helps manage symptoms effectively, prevents complications, and improves quality of life by identifying and treating the underlying autoimmune condition.

What diagnostic tests are used for autoimmune hives?

The Basophil Histamine Release Assay and Autologous Serum Skin Test are key diagnostic tools. They help identify autoimmune responses contributing to chronic hives.

What general management strategies exist for autoimmune hives?

Management includes avoiding known triggers, stress management, and regular monitoring. A holistic approach focusing on both physical and emotional well-being enhances treatment effectiveness.

What are the treatment options for autoimmune hives?

Treatment options range from antihistamines and anti-inflammatory medications to immunosuppressants and biologic drugs tailored to reduce immune system overactivity specifically targeting the cause of hives.