Can stress cause hives and how are they treated?

From the Guidelines

Yes, stress can cause hives, which are itchy, raised welts on the skin that occur when the body releases histamine in response to stress or other triggers. Stress-induced hives are a common condition that can be treated with various methods. The primary treatment for stress-induced hives includes antihistamines such as cetirizine (Zyrtec) 10mg daily, loratadine (Claritin) 10mg daily, or diphenhydramine (Benadryl) 25-50mg every 4-6 hours as needed 1. For severe cases, a doctor might prescribe stronger antihistamines or a short course of oral corticosteroids like prednisone. Some key points to consider in the treatment of stress-induced hives include:

• Applying cool compresses to affected areas can provide immediate relief
• Taking cool baths with colloidal oatmeal can soothe the skin
• Stress management techniques are also important for preventing recurrence, including meditation, deep breathing exercises, regular physical activity, and adequate sleep
• Avoiding known triggers, wearing loose-fitting clothing, and using fragrance-free soaps and detergents can help prevent flare-ups
• If hives persist for more than a few days or are accompanied by difficulty breathing, facial swelling, or dizziness, immediate medical attention is necessary as these could indicate a more serious allergic reaction, such as anaphylaxis, which requires prompt epinephrine injection 1. It is essential to note that while stress-induced hives can be uncomfortable and itchy, they are generally not life-threatening, but it is crucial to monitor for any signs of anaphylaxis, which can be fatal if not treated promptly 1.

From the FDA Drug Label

Epinephrine also alleviates pruritus, urticaria, and angioedema and may relieve gastrointestinal and genitourinary symptoms associated with anaphylaxis because of its relaxer effects on the smooth muscle of the stomach, intestine, uterus and urinary bladder The FDA drug label does not answer the question of why stress can cause hives, but it does mention that epinephrine can alleviate urticaria (hives) associated with anaphylaxis 2.

• Stress is not directly mentioned in the provided drug labels as a cause of hives.
• Treatment of hives (urticaria) may involve medications such as epinephrine or prednisone, depending on the underlying cause and severity of the condition 2 3.

From the Research

Can Stress Cause Hives

• Stress can contribute to the development of hives, also known as urticaria, as it can trigger the release of histamine, a chemical that causes blood vessels to dilate and lead to the formation of wheals and flares 4.
• Chronic stress can continue to increase histamine turnover in certain areas of the brain, which may play a role in preventing stress vulnerability 4.
• Psychosomatic involvement is also observed in many patients with chronic urticaria, suggesting a link between stress and the development of hives 5.

Treatment of Hives

• Antihistamines, particularly H1 antihistamines, are the mainstay of treatment for urticaria, as they can help alleviate symptoms by blocking the action of histamine 5, 6, 7.
• Second-generation antihistamines, such as loratadine, cetirizine, and mizolastine, are preferred over older antihistamines due to their reduced sedative and anticholinergic effects 6, 7.
• In some cases, combination therapy with H1 and H2 antihistamines may be effective in treating certain forms of urticaria, such as urticaria factitia 5.

Considerations

• Hypersensitivity reactions to antihistamines can occur, although they are rare, and may manifest as urticaria, angioedema, or anaphylaxis 8.
• Diagnosis of hypersensitivity reactions to antihistamines can be challenging, and challenge testing may be necessary to identify a tolerable alternative 8.