Rashes and Hives

Causes of Chronic Urticaria and Angioedema in Autoimmune Diseases

Feb 4, 2007
Elaine Moore

Persons with autoimmune disorders, especially thyroid disorders, lupus and Sjogren's, are at risk for rashes, hives and urticarial vasculitis.

Rashes and hives, which are technically referred to as urticaria and angioedema, are common occurrences in people with allergies and autoimmune diseases. Urticaria is defined by rashes that are characterized by a raised swelling of the skin with itching that typically lasts no longer than 24-48 hours. Angioedema presents as a deeper, nondependent swelling without itching. In certain types of urticaria and angioedema, the underlying cause is autoimmunity related to the presence of t hyroid antibodies or an acquired C1 inhibitor deficiency.

The cumulative lifetime incidence of urticaria is estimated to be as high as 20 percent in the general population. The most common cause is IgE mediated (allergic) reactions to food or drugs. The cause is mast cell degeneration with release of histamine caused by the formation of IgE antibodies. When the offending trigger is identified and removed the urticaria resolves.

When the solution isn’t as simple and urticaria persists for longer than 6 weeks, the condition is known as chronic urticaria. Approximately 50 percent of patients with chronic urticaria also have conditions of angioedema. When both conditions are present the condition is seldom related to allergy and it is known as chronic idiopathic urticaria/angioedema.

The Role of Thyroid Antibodies

Several groups of researchers have described a relationship between chronic urticaria and thyroid disease, primarily Hashimoto’s thyroiditis and to a lesser extent Graves’ disease. These patients typically have levels thyroid peroxidase antibodies. In general, these patients had severe chronic urticaria/angioedema and no other signs of thyroid disease although some patients had a slight goiter. Treatment with levothyroxine caused improvement in the urticaria and angioedema. When treatment was stopped the symptoms returned and then subsided with the continuation of treatment. In the patients without evidence of thyroid antibodies, levothyroxine had no effect. The pathogenic relationship between thyroid antibodies and the chronic urticaria hasn’t yet been determined.

Anti-FceRIα antibodies

Another group of patients with chronic urticaria were found to have autoantibodies to FceRIα. These patients reacted to serum from normal subjects with wheals and flares.

Urticarial Vasculitis

Chronic urticaria may also be associated with a leukocytoclastic (white blood cell-mediated) vasculitis confined to skin or to a wider area of connective tissue. Palpable purpura (small purplish bruises) and urticaria of long duration are typically seen in urticarial vasculitis. Urticarial vasculitis often occurs in systemic lupus, polymyositis, mixed cryoglobulinemia, and Sjogren’s disease and tends to be associated with low levels of C1q.

C1 Inhibitor Deficiency

Patients with C1 inhibitor deficiency often have recurrent attacks of angioedema. C1 inhibitor is a multifunctional serine protease inhibitor that inhibits the immune system’s complement system. Complement represents a number of immune system chemicals. In patients with autoimmune diseases, C1 inhibitor may be catalyzed at an accelerated rate, causing an acquired C1 inhibitor deficiency and resulting angioedema. These patients generally have anti-idiotypic autoantibodies, which are thought to activate complement and lead to the C1 inhibitor deficiency.

Resources:

Bruce Zaraw, Urticaria, Angioedema, and Autoimmunity, Progress and Controversies in Autoimmune Disease Testing, Clinics in Laboratory Medicine, Philadelphia: W.B. Saunders, 1997.

Dreyfus, DH, Steroid-resistant chronic urticaria associated with anti-thyroid microsomal (peroxidase) antibodies in a 9-year old boy, Journal of Pediatrics, 1996; 128.

Elaine at NYC Best of Reference Library Awards, Lisa Moore

Elaine Moore - I'm a retired medical technologist and medical writer with more than 30 years experience working in hospital laboratories. Currently, I ...

Comments

Feb 9, 2009 7:01 PM

Guest :

hello! I have had 2 -3 episodes of angioedema per year for the last 15 years (I am 60, female, post menopausal, have both celiac and sjogren's diseases). Our rescue dog had to begin treatment for severe pulmonary hypertension and damaged valves with a combination of an ace inhibitor (Enalopril), a bronchodilator (Theophylline), and a vasodilator (Pimobendan). When I began administering these meds, I had 6 episodes of angioedema within 5 weeks (throat, tongue, feet, hands). I can only presume that handling these drugs (or just the Enalopril) is as reactive as ingesting them myself! Has anyone else observed a similar reaction? (I now use gloves + a dust mask when giving our dog his meds.)
Regards,
Susan

Feb 10, 2009 9:45 AM

Elaine Moore :

Hi,
If the gloves take care of the problem it likely is the enalapril. I had a similar reaction to anafranil. Best, Elaine

Mar 4, 2009 8:29 AM

Guest :

Have had hives daily for 3 months now. thyroid antibodies are elevated and was diagnosed with Hashimotos thyroiditis yesterday. But Dr. didn't want to treat yet, saying eventually it would turn into hypothyroidism and he will treat that. So for now, I guess I have to live with the hives.

Mar 4, 2009 8:30 AM

Guest :

Mar 5, 2009 8:14 AM

Elaine Moore :

Hi,
I'm surprised your doctor hasn't started treatment. When thyroid antibodies are present, thyroid hormone is often started. Other treatments used for hives include diphenhydramine (Benadryl), hydroxyzine (Atarax), corticosteroids, vitamin A, and Zantac. I hope some of the topical preparations bring your relief. Perhaps you can get a referral to see a dermatologist. Best, Elaine

Mar 7, 2009 11:06 PM

Guest :

I have had urticaria vasculitis for 12 years now.In the first few years medications didnt seem to work.When I went unmedicated is when I started to seperate side effects from symptoms.I react to a variety of things(ice,sun,foods,medications,presure against my skin & most of all stress)so to keep away from these things has been more benifical than anything.There are times breakouts occure & meds are needed but you must identify what your triggers are.I am now having problems with gut pain & headaches & I cant seem to get my Dr. to see it could be the Urtcaria Vasculitis.I have only been using benadril & ibuprophin for years because I grow ammune to other meds so fast & I know there will come a day they have to work to save my life.How do you explain to a Dr. Urticaria Vasculitis?

Mar 9, 2009 10:18 AM

Elaine Moore :

Hi,
You're doing a great job of keeping symptoms in line. Avoiding triggers is so important.
Over time, ibuprofen can cause gut pain. I know some of the doctors at National Jewish are using a combination of Zantac, Zyrtec and thyroid hormone (if thyroid antibodies are present).
You might want to see if there's an immunologist in your area. Best, Elaine

Mar 16, 2009 10:57 AM

Guest :

For the guest - FIND ANOTHER DOCTOR. Thyroid hormone was the only thing that helped my 12 year old duaghter with chronic hives, who had normal thyroid function, but elevated anitbodies. Her thryroid eventually became underactive, but we still needed periodic increases of thyroid hormone to contol the hives. Thankfully, after 6 years of bouts of hives, she has been hive-free for almost 6 years. We also saw doctors at National Jewish who specialized in the immune system. Don't give up - hive is a "four letter word" for sure!

Apr 7, 2009 9:20 AM

Guest :

I've just been diagnosed with Hashimoto's thyroiditis after suffering with hives and angioedema for two months. I first went to an allergist who determined the cause was not a food allergy but elevated TPO sent me to an endo. He has me on small doses of synthroid. I'm wondering if I continue with the allergy medication (Zyzol, Zantac, hydroxyzine) and the hives clear up, how will I know if the synthroid is what worked or the allergy meds? I hate the idea of taking medication but don't like suffering either. Any ideas are appreciated.
~Dee

Apr 7, 2009 9:28 AM

Elaine Moore :

Hi,
Since you've been diagnosed with Hashimoto's thyroiditis, you probably need to be on thyroid replacement hormone to keep your levels in an optimal range. This will also slow your gland's activity down and help reduce thyroid antibody production. The other meds will help inhibit the allergic reaction.

Most people I know who have the same problem as you are on thyroid hormone, zantac, and either zyrtec or claritin. Over time, they've been able to reduce the antihistamine, using it only at night or as needed.

You'll probably need to continue on the replacement hormone, and as your symptoms abate discuss with your doctor the possibility of cutting back on or stopping the other meds. Best, Elaine

Apr 7, 2009 3:02 PM

Guest :

Apr 14, 2009 11:45 AM

Guest :

Elaine,
I have suffered from chronic hives since I was 16; I am now 29 and having outbreaks of hives again. I usually have an outbreak every 3 to 5 years. I was diagnosed with Hashimotos thyroiditis several years ago and have been on levothyroxin since. My thyroid level was tested when this recent outbreak occured and my levels are fine. My doctor has me on a combination of Zyrtec and Doxpin, but the hives are still happening. Are there any other medications that help hives? Should I see another doctor?

Apr 14, 2009 12:24 PM

Elaine Moore :

Hi,
Your thyroid hormone levels may well be within the normal range, but they still may be too low for your body's needs, especially if your doctor is measuring you with TSH alone. When FT4 and or/FT3 are too low, the immune system produces more thyroid antibodies as it speeds up its activities trying to fix the problem. This increased thyroid antibody production is what seems to cause the hives.
Most doctors who treat this use zantac, zyrtec, hydroxyzine, or claritin, nasal steroids and adequate thyroid hormone. I hope it's not doxepin your doctor is using. This is an antidepressant and wouldn't be useful.
It'd be good if you could see an immunologist who's familiar with this or a good dermatologist. Best, Elaine

Apr 14, 2009 10:18 PM

Guest :

Hi, I have had cronic hives 4 months now recently had a blood test which came up positive for autoimmune problem with all other functions normal. For a while I was holding the hives at bay with a single antihistimine a day now two of the same give no relief. The doctor claims it is likely to go away eventually. Am I doing more harm by not medicating and just putting up with the hives as long as I can or should I start taking heavier meds?

Apr 15, 2009 5:13 AM

Elaine Moore :

Hi,
It's probably more of a case of needing the right medications than more medications. Often, hives are caused by reactions to foods and medications or they can be due to an autoimmune thyroid condition, which doesn't necessarily cause a thyroid disease. It would be good to see an allergist or immunologist who can run the correct tests and determine the best treatment. Take care, Elaine

May 1, 2009 8:08 AM

Guest :

For the Guest's comment, dated April 14th. When my daughter, who was on thyroid replacement for Hoshimoto's, would have a bout of hives that were not controlled by other meds; her doctor at National Jewish would increase her dosage of synthroid - more than she needed to maintain
in-range levels of TSH, T4, T3, etc. We watched for signs of hyperthyroidism and he did blood tests to moniter the levels to make sure they did not get too far out of range. For example, one time her dosage was increased from 125mg to 200mg for a period of time to get the hives under control and then it was gradually cut back to a normal dose. That was how we managed her hives for 6 years. Hope this helps.
Good luck to you.
Connie

May 22, 2009 2:36 AM

Guest :

I've had urticaria for 4 weeks and it isn't responding to anti-histamines. I've had a 3 week course of steroids but the urticaria comes back as soon as I stop taking the steroids. My doctor has referred me for allergy testing whcih will take 6-8 weeks and says it's unlikely to be related to a thyroid problem. I was diagnosed with Grave's disease 10 years ago, treated with carbimazole and then stabilised. I became hyperthyroid again 3 years ago. My levels were 10 times what they should have been and I suffered massive weight loss and sever palpitations; diagnosis - Graves disease. I was treated with radioactive iodine and became hypothyroid. I am currently on 225mg of levothyroxine a day. I suffered massive angioedema 16 years ago - the doctors called it angioneurotic edema at the time and put it down to an allergic reaction to penicillin. I was hospitalised for over a week. I also suffered from sever abdominal pains the same year and was admitted for an appendectomy. My appendix was removed despite being intact - the doctors were unable to establish the case of the pain. I have vitiligo in my groin and armpits. There's a history of alopesha, over and underactive thyroid disease; ulcerative colitis; rosatia; epilepsy and hormonal cancers in my immediate family.I'm convinced my connditions are related - there is definitely an auto-immune link but my doctors think I'm nuts! Any advice???

May 22, 2009 8:57 AM

Elaine Moore :

Hi,
I'm sorry to hear about your 4-week episode of urticaria. There's a clear association between thyroid antibodies and urticaria, and thyroid antibodies increase dramatically after RAI.
You might also want to read this article, autoimmunedisease.suite101.com/article.cfm/thyroid_peroxidase_antibodies

In general, patients are put on Zantac, antihistamines like Zyrtec, and sufficient thyroid replacement hormone. After RAI, TSH levels are usually falsely decreased so it's important to look at FT4 and FT3 levels. Having adequate thyroid hormone and avoiding environmental triggers such as excess dietary iodine will help reduce your thyroid antibody levels. Best, Elaine

Jun 3, 2009 3:11 PM

Elaine Moore :

Hi,

Because you mentioned your bottom, dermatitis herpetiformis comes to mind. This is a condition that can occur in gluten sensitivity, thyroid conditions and other autoimmune conditions. You may want to read my articles on chronic urticaria in thyroid disease and dermatitis herpetiformis and also this one on tpo antibodies:
autoimmunedisease.suite101.com/article.cfm/thyroid_peroxidase_antibodies< br />
Let me know what you think. Best, Elaine

Jun 3, 2009 6:50 PM

Elaine Moore :

Hi,
Your doctor may have tested you for thyroid function with TSH, FT4 and FT3 tests but he may not have tested you for thyroid antibodies. It's important to have tests for TPO antibodies since they're associated with both angioedema and miscarriages.
see autoimmunedisease.suite101.com/article.cfm/thyroid_peroxidase_antibodies

One of the most common causes of multiple miscarriages is antiphosholipid syndrome
See autoimmunedisease.suite101.com/article.cfm/antiphospholipid_syndrome_ aps
This is also an autoimmune disorder in which antibodies cause the blood to clot too soon. Although you mentioned one miscarriage, it might be good to test for APS while having tests for TPO antibodies. Best, Elaine

Jun 4, 2009 10:04 AM

Guest :

Guest:
I am a thirty year old male. Some two and a half months back, while I was sleeping, I felt a bit of itching sensation in my inner palms and hands. At that time I concluded that it was an insect bite and did not give it much importance. Then the itching grew more intense with every passing night. One night I felt a bit of itching sensation on the rim of my lower lip and when I scratched, after some time, one side of my lip got swelled and till morning it had migrated to the other side of my lip. After taking citrazine the condition faded away till midday. But after that, I repeatedly used to get these swellings and red spot at different locations of the body. The areas most affected include lips, hands, fingers, eyes. Once or twice my private parts also got involved. I consulted a couple of doctors who diagnosed me with chronic urticaria/angioedema and prescribed levocitrazine. After taking the drug, i do get relief but once i discontinue the drug the condition reoccurs. The condition is getting more and more worse day by day. I also tried to identify the allergin but in vain.

Jun 4, 2009 7:49 PM

Elaine Moore :

Hi,
I could see where the citrizine meds would help if you had a response to a bug bite. But angioedema and hives often start with itching in the hands. It would be good to have tests for thyroid antibodies to see if you might be having a thyroid antibody mediated response. Best, Elaine

Jun 12, 2009 12:25 PM

Guest :

I was diagnosed w/ Hashimotos thyroiditis about 3 years ago & have had hives for about 6 weeks, my endo. sent me to an allergist, she ran some blood test but I haven't gotten the results yet. In the mean time she perscribed Allegra but that doesn't help at all, the only thing that helps is Benedryl but it makes me so sleepy, any suggestions?

Jun 13, 2009 7:54 PM

Elaine Moore :

Hi,
I'm sorry to hear about your hives.
Hives are often caused by allergies to food and/or medications and they can occur when thyroid hormone levels are low in people with TPO antibodies. These antibodies are typically seen in Hashimoto's thyroiditis. If no allergies show up in your tests you might want to ask about the role of thyroid antibodies. Best, Elaine

Jun 30, 2009 5:31 PM

Elaine Moore :

Hi,
Childbirth can cause some significant immune system changes. Women occasionally develop thyroid antibodies, specifically TPO antibodies, although they don't necessarily develop thyroid disorders. These antibodies can be associated with rashes. Although you don't want skin tests, there are blood tests such as RAST tests for allergens, and tests for TPO antibodies that could help with your diagnosis. Congratulations on your new baby! Best, Elaine

Jul 15, 2009 4:05 PM

Elaine Moore :

Hi,
Chronic idiopathic urticaria can be accompanied by vasculitis. Best, Elaine

Aug 24, 2009 5:53 PM

Elaine Moore :

Hi,
I'd see a rheumatologist experienced in vasculitis rather than a dermatologist for your condition. It would be a good idea to have tests for thyroid antibodies. If they're present thyroid replacement hormone may be needed. Best, Elaine

Aug 24, 2009 5:58 PM

Elaine Moore :

Hi,
I think it's best to find out the cause of your rash and swelling rather than use constant medication to control symptoms. I've had a similar problem that was caused by cooked celery, bee pollen, soy, and a few other foods. I would have never figured this out if I hadn't seen a good allergist/immunologist. Doxepin is a tricyclic antidepressant that can help reduce the stress response. Best, Elaine

Aug 29, 2009 7:53 PM

Elaine Moore :

Hi,
Your allergist should realize the importance of your high IgE. Hives can be from allergies to foods and medications. This can result in a high IgE. Some seemingly innocuous medications, like blood pressure meds and innocent foods like tomatoes, can cause hives.
I'd see if you can find the articles on thyroid antibodies and urticaria and see if you can have tests for thyroid antibodies. But still, you should have a complete workup for allergens. Allergic reactions can increase thyroid antibody production causing a vicious cycle of rashes and hives. Best, Elaine

Sep 30, 2009 1:49 PM

Guest :

Hello. I am a 29 year old female diagnosed with Hashimotos Thyroiditis. I have had chronic hives, which have become progressively worse, over 3 yrs. I have a multinodular goiter. Dx by allergist. My new endocrine doc has me on synthroid, xyzal, zantac and claritin. This seemed to work for 6 months, now hives are back with periods of relief. Levels are "normal". I have to take courses of steroids to function at work and those have their own problems. Any other otc supplements that can help? Do I continue with steroids, ask for an increase in Synthroid, or consult an ENT for thyroidectomy?...kinda desperate for relief.
thanks,
karen

Sep 30, 2009 2:43 PM

Elaine Moore :

Hi Karen,

Often, increasing Synthroid, using your FT4 level as a guide and making sure it's not higher than the high end of the range, can help. Vitamin A and vitamin D also may help.
If you're allergic to any medication or food avoiding it is necessary. Even seemingly innocuous substances like BHA and BHT used as food preservatives can trigger hives.
Avoid any immune system triggers like vaccines as well. Low dose naltrexone (LDN) may also offer benefits since it modulates the immune system. See my articles on LDN and on adaptogens too. Best to you, Elaine

Oct 9, 2009 1:36 AM

Guest :

I am 30 years old and I have the hives and angioedema every day for the last 16 years. I have been put on every allergy drug available and they work for a while then my body becomes tolerant and they stop working not to mention some are very expensive. Also I've had this so long that doctors don't believe me when I give my history to a new doc. I have been on steroids and in the first year using them I gained almost 70 pounds, and they stop working after the first week and I have to switch to a new one as well. Sometimes I swell up so bad I can't walk, move my fingers or hands, my face begins to develop big hard lumps, my eyes swell shut and my lips swell up to about 3 times the normal size. I have had to take so much benedryl I have also developed high blood pressure. I'm in so much pain most of the time all I can do is cry. After the hives and swelling go away my entire body feels like I've been beaten and I am sore and bruised it hurts in some places like my fingers and knees right down into the joint. I have been to every kind of specialist available to me and they had no answers and I know it is not an outside allergen. The docs I've seen have to be missing something or they just don't want to deal with it, I don't know, but I am at the end of my rope. I would just like yo know what I have so I can treat it. I have lost jobs because of this and I am so far in debt because of medical problems as well I can't afford to go in circles with the specialists and tests and so on. If anybody has any answers please post them. Thank you, Amy

Oct 9, 2009 6:17 AM

Elaine Moore :

Hi,
You haven't mentioned being tested for thyroid antibodies. They can be the cause of chronic urticaria and angioedema. Treatment is with thyroid replacement hormone.
Ask about having tests for these antibodies and see if you can find the articles listed in the resource section of this article. Best, Elaine

Oct 14, 2009 3:51 PM

Guest :

I was recently put on Synthroid after discovering I had a slightly elevated TPO-Ab level (130-149) and a TSH level between 4.79-5.01. My TSH has come down to the 1.0 range (my medication was adjusted after it dipped too low and I was having some anxiety), but my TPO-Ab have stayed about the same. I have also suffered from hives on my face and neck since 1992 or 1993. I had no idea that the TPO-Ab could be related to the hives. I have also had at least two miscarriages (which is why the thyroid tests were done). I'm now trying to get pregnant again after about 5 months on Synthroid. Is there something else I should be taking to lower my TPO-Ab level? The hives seem to be lessening, although I have outbreaks around ovulation and when I get my period (some months worse than others). I'm wondering if my hives and TPO-Ab were caused by an allergic reaction to penicillin or perhaps exposure to TB? (I took INH for 6 months after a positive TB skin test in 1993.) I have had hive outbreaks while dusting and after eating spicy foods or shellfish, but not in every situation. Stress also seems to make them worse. I have never been tested for allergies. Every time I think I know the cause of the hives, it seems my theory is wrong. I have been treating the hives with topical hydrocortisone for years and hope it isn't doing more harm than good. (I got too sleepy taking benadryl tablets, even the children's strength, and claritin and zyrtec only worked for a little bit.) At this point I am most concerned about getting and staying pregnant, but would also love to find a cure for the hives. I'm hoping the thyroid meds will do the trick, but any other advice you have would be appreciated.
Thanks, Valerie

Oct 15, 2009 9:29 AM

Elaine Moore :

Hi Valerie,
One recent study showed that taking adequate selenium (200 mcg daily) can help lower thyroid antibodies. Selenium is needed for proper thyroid hormone metabolism. I wrote an article on this that you can find on suite101.

Many of us with hives find that stress and even exercise can trigger hives if we've eaten certain foods. For me, it's cooked celery, bee pollen, and a few other things. Having allergy tests can help.

Being on Synthroid should also help lower your TPO abs as your gland can settle down. In hypothyroidism (TSH higher than 3.0) the gland works to try to correct the problem and all activiities, including thyroid antibody production, increase. Best, Elaine

Oct 16, 2009 7:46 AM

Guest :

Hello, I have had hives (urticarial vasculitis) for the past 11 years. At first I was on every antihistamine made but they did nothing. The only
medication that helped me was prednisone. I had every blood test under the sun done and all were normal including thyroid. I break out every other year or so and the hives stay for at least a year. My rheumotologist put me on 400mg of plaquenil (hydroxychloriquine) daily and once in my system I am hive free. But only while on this med am I hive free. I just wanted to mention this because I did not read that anyone else has tried this. The only other time I am hive free is when I am pregnant!! I just wish someone would find a reason WHY all of a sudden I woke up one day with hives and now they never go away!

Dec 10, 2009 10:51 AM

Elaine Moore :

Jenny,
I'd ask for tests for TPO antibodies to see if they're contributing to your hives. TPO antibodies are also implicated in miscarriages. In cases where TPO antibodies are present, thyroid replacement hormone is used and often helps.
Read my new article on gluten intolerance too. You may not have specific food allergies but you could have intolerances to wheat or soy. Look up pleural edema too and see what you think.
Best, Elaine

Jan 2, 2010 8:16 PM

Elaine Moore :

Hi,
Read my article on using selenium to reduce thyroid antibody titers.
www.suite101.com/blog/daisyelaine/reducing_thyroid_antibody_titers
Anything you do to help your immune system heal will help reduce thyroid antibodies, including avoiding environmental triggers of autoimmune thyroid disease such as excess dietary iodine in processed and fast foods, stress, aspartame, etc.

Many doctors treat hives related to TPO antibodies with Synthroid, Tagamet (cimetidine), Zyrtec and/or Claritin. Best to you, Elaine

Jan 20, 2010 5:59 PM

Elaine Moore :

Hi,
It sounds as though your daughter had PTU-induced hypothyroidism and then she had passive hyperthyroidism due to placental transfer of your TSI antibodies. These typically break down within 2-3 months and are then excreted in the urine.
At birth, she would be too young to produce her own antibodies. The immune system doesn't fully mature until around age 2.

Two things come to mind. She could have TPO antibodies and this could be causing the rash....although it would be unusual for her to already be producing these antibodies. She could also have dermatitis herpetiformis, which is similar to gluten intolerance. Read my article on this. Also, food allergies, particularly to milk, soy, and wheat, are fairly common in our family members.
Best, Elaine

Mar 2, 2010 9:14 PM

Elaine Moore :

Hi,
You should have had tests for thyroglobulin and TPO antibodies. These thyroid antibodies are seen in autoimmune hypothyroidism (Hashimoto's thyroiditis), and most hypothyroidism is autoimmune. These antibodies frequently contribute to the hives seen in thyroid disease. Many doctors use Zantac and Claritin or Zyrtec along with thyroid replacement hormone to reduce the hives. Studies show that some people with this condition also have low vitamin A levels. Beta carotene or vitamin A supplements are worth a try.
If you're new to thyroid replacement hormone you might notice some temporary symptoms of hyperthyroidism like palpitations or increased blood flow to the thyroid----these symptoms don't mean that you're hyperthyroid but they can occur as your body acclimates to the changed levels. Unless your levels are too high, your symptoms should resolve within a week.

If these symptoms are new and developed after you'd been on replacement hormone for a while you should call your doctor and ask to have your labs checked. Sometimes hypothyroidism occurs as the initial phase of hyperthyroidism in Graves' disease.

It's also important for you to keep copies of your thyroid function test results so you can stay on top of things. You want to make sure you're having tests for FT4 and FT3 and not just TSH to make sure you're on the right type and right amount of replacement hormone. Some people need both T4 and T3 replacement hormone.

It's also a good idea to avoid the environmental causes of autoimmune thyroid disease, especially excess dietary iodine in fast and processed foods. Best to you, Elaine

Mar 19, 2010 2:31 PM

Azora Nichols :

Hi, Elaine....Wow, what a topic of response! I'm really surprised (and kind of heart-heavy) that so many people had a personal reaction to this subject.

I'm a Suite101 writer, too. One of the reasons I have to work from home is because of my autoimmune deficiency. I developed angeodoema when I was 15, and chronic hives persisted for nearly a year, afterwards. Then again, the hives came back at 18 (which lasted for a slightly shorter period of time). At 21, another, bout...until finally, at 23, I had my last episode (so far, five years ago). But I'm pretty sure I have lupus. Because when it isn't hives, it's something else...

Anyway, I'm just curious what made you write on this topic? Do you have a personal interest in it, or did you research common medically "googled" terms? I only wonder because it's amazing to me the outpouring of response you've had over this article (I'm sure it also has to do with how well-written it is, of course!). Also, are you a doctor? (I'm sorry if I missed that somewhere in the posted comments). If so, I'm interested to know what you think about the lupus angle. I have the butterfly rash, nausea, joint pain, malaise, sporatic fever, (apparently) psoriasis (or eczema)...actually, that's a new symptom, just started happening on my fingers. Weird.

Sorry! I got off-topic there....great article, though. Nice work ^_^

Cheers!

--Azora ("Zoe") Nichols

Mar 19, 2010 7:24 PM

Azora Nichols :

Hi, Elaine,
Since I first commented, I did go ahead to your page (I figured your credentials would be there...and they were!). You most definitely know quite a lot on the topic of autoimmune disease. It seems to be a common problem, for more and more people.
But I actually wanted to ask you a few more things (if you don't mind): if a person has a serious autimmune/ rheumatic disease, is it true that immune suppression is a treatment? And isn't that, like, chemotherapy? For people with cancer? And are the two in the same family of diseases!?
Sorry. That was about five questions.
I've been seeing a nutritionist, and I'm scheduled to have blood work done next week (and we are checking my thyroid at that time). And I've already been in once, complaining about a generally "ill" feeling I've had for the last few years, off and on.
By the way, I only had angeodema once, but it went away in about a week, to become vascular urticarea. My urticarea (when I get it) is serious, and debilitating.
The weirdest part about this whole thing is that in the last two months, i've probably been healthier than I've been in the last four years (taking supplements religiously, eating more/ better, and even taking omega 3's, for the first time). But suddenly an itchy outbreak seems to be coming on, and I've developed this completely new symptom on my hands (which i'm convinced is eczema). Why now? Is it because I'm boosting my wonky, masocistic immune system, to do it's silly self-defeating thing even BETTER?
Oh, dear. This is too long now. I shall stop. Thanks for listening me!
--Zoe (don't worry about calling me Azora...that's just my legal name!)

Mar 20, 2010 4:24 PM

Elaine Moore :

Hi Zoe,
There's a few different theories but the most common one is that autoimmune diseases are caused by a weak, ineffective immune system (that's been overburdened by infections, chemicals, etc). Weakened, the immune system no longer works like it should and it fails to distinguish "self" from foreign molecules. So it over-reacts and targets the body's own proteins. In the process the immune system produces autoantibodies, which are antibodies directed against the body's own proteins.

Immunosuppressants slow down the immune system, reducing production of immune system chemicals (cytokines) that promote inflammation, and reducing autoantibody production. In this way they benefit most autoimmune diseases. In cancer these same drugs slow down tissue proliferation, reducing tumor growth.

Both disorders are caused by an immune system that's not properly functioning. Normally, the immune system would destroy mutated, cancerous or otherwise damaged cells.

Any chance you're eating something you're allergic to and in this way worsening the autoimmune reaction. I think of wheat. See my article on dermatitis herpetiformis. Best, Elaine

Jun 28, 2010 7:50 AM

Elaine Moore :

Since you've had cellulitis in this area you may want to have it checked out. Topical diphenhydramine (Benadryl) is used on rashes due to bug bites or mild allergies. best, elaine

Jul 21, 2010 9:51 AM

Elaine Moore :

I don't think your son's past use of immunosuppressants are contributing to hives. They may have helped suppress any hypersensitivity reactions and you didn't notice hives. Hives are often caused by hypersensitivity see http://autoimmunedisease.suite101.com/article.cfm/hypersensitivity_reaction s

Common causes of hives are stress, medications and foods. Sometimes foods that normally don't cause problems trigger a reaction during exercise or stress. I react this way to celery, bee pollen, and sometimes tomatoes. You could try removing the top 10 allergens (like eggs, soy, wheat, dairy, etc) and watch as you slowly add them back. Check with your doctor too to see if medications are needed. best, elaine

Aug 11, 2010 8:20 PM

Elaine Moore :

Hi,
Impetigo is caused by infection with Staphylococcus and it's not associated with hyperthyroidism.

Aug 12, 2010 5:18 PM

Elaine Moore :

Recurrent miscarriages are seen in antiphospholipid syndrome. see my article on this topic and also autoimmune infertility and also hypersensitivity. hypercoagulation disorders like antiphospholipid syndrome are the most common cause of miscarriages and also strokes in young women. this condition is easy to treat once it's diagnosed, and people with it can also have hypersensitivity, immune system irregularities and other autoimmune conditions or thyroid antibodies that are associated with rash. best, elaine

Aug 23, 2010 10:51 AM

Elaine Moore :

the med may have been coincidental or it could have triggered a hypersensitivity reaction. read my article on this subject. also, since your symptoms are seasonal you may be reacting to seasonal allergens such as pollens or grasses. it would be good to have RAST tests and also tests for C1 inhibitor deficiency and for thyroid antibodies. this would help you learn the cause and not just ways to reduce symptoms. best, elaine

Sep 2, 2010 8:07 PM

Elaine Moore :

regarding your thyroid problem, if you have thyroid antibodies as described in this article, treatment is generally with replacement hormone to lower the antibodies along with zantac and rantidine. check your lab results and see if you have either TPO or thyroglobulin antibodies. best, elaine

Sep 6, 2010 8:13 PM

Elaine Moore :

Hi Kat,
it would be good to see an allergist or immunologist to see what's causing your hives. a doctor can also prescribe more effective remedies. best, elaine

Oct 9, 2010 9:13 PM

Elaine Moore :

Hi,
Doxepin is an antidepressant rather than an antihistamine. Hives are often treated with hydroxyzine. Hives can occur when vitamin A levels are low. Have you had your vitamin D level checked? People with low vitamin D levels (about 75% of the population) often have low vitamin A, K, E and CoQ10 levels too. This would be worth checking into.

Hives can be caused by stress and the most common causes are medications and foods. I've gotten them from cooked celery, tomatoes, bee pollen, and some very strange things. I also have many food allergies. Since you've had them long-term and haven't mentioned any regular meds, you might consider eliminating common allergens such as soy, eggs, etc or ask your allergist to run skin tests and RAST tests. I know people who get hives from lavender and various herbs too. Along with the vitamin D level so you can see what supplements might help.

Oct 25, 2010 10:18 AM

Elaine Moore :

regarding your rash after having RAI for hyperthyroidism, read my articles on atypical symptoms in graves disease, skin conditions in thyroid disease, and dermatitis herpetiformis. I developed gluten intolerance after RAI. Eliminating wheat would be worth a try and so would making sure your FT4 is at least at midrange since the TSH level can be falsely decreased after RAI. best, elaine

Nov 15, 2010 10:25 PM

Elaine Moore :

regarding the blood tests you had, you probably only had a TSH test, which screens for thyroid disorders. You'd also need tests for thyroid (TPO) antibodies and ideally you'd also have FT4 and FT3 levels. there are other causes of rashes and hives and your immune system can change course after pregnancy. You could have developed allergies that you never had before. Hives are often caused by food or medication allergies.

Nov 16, 2010 9:54 AM

Elaine Moore :

It's good to hear that your rash cleared up within a week of using 25 mcg levothyroxine. The TSH level can be misleading since certain thyroid antibodies can suppress it. Your FT4 level is a better indicator of your thyroid status. Your low dose may need to be increased but as long as FT4 remains in range this isn't a problem. You might want to read my article on the use of selenium for lowering TPO antibody levels.

Dec 7, 2010 10:35 PM

Elaine Moore :

Hi,
thyroid replacement hormone is generally used to treat hives associated with thyroid antibodies. Often, a regimen of levothyroxine, zantac and zyrtec is used. National Jewish in Denver has a protocol for this. I'd ask about trying this before having more allergy tests. best, elaine

Jan 25, 2011 1:24 PM

Guest :

hi there,
ive been suffering chronic urticaria for the past 5 yrs now and treatment doesn't seem to be working any more, my feet swell up to the point where i cant walk and its painfull my hands also swell up.
it seems to break out when am in the bath,sun,cold,wearing boots with heals,if i feel hot or stressed or if theres pressure on my skin. im now starting to feel depressed cause it doesnt seem to be going away i also dont get any sleep cause im constantly scratching to the extent that i bleed it dont seem to matter what i do as its there all the time and nobody seems to know whats causing me to suffer this can you help me as i dont know what to do anymore ive tried everything i can think of , i dont know how much more i can take!

Jan 26, 2011 6:55 PM

Elaine Moore :

regarding your worsening rash, there are new tests that can better pinpoint what you're reacting to. Check with an allergist or immunologist. Also, have tests for TPO antibodies to see if treatment with thyroid hormone might be helpful.

Jan 26, 2011 6:56 PM

Elaine Moore :

Feb 18, 2011 1:24 PM

Guest :

VERY GOOG

Mar 7, 2011 8:14 AM

Guest :

You're just the person I'm looking for. Every winter for the last ten years the slightest scratch on my hands causes the entire area to swell up and get an itchy, weepy rash. After a week or so, the skin hardens and splits, eventually peeling off. This year, for the first time, the scratch was on my forearm, and my entire arm plus both hands and my side got it. The doctors I've seen don't know what to make of it (a dermatologist told me "if you ever find out what that is, let me know!"). Does this sound like what you're discussing here? What should I do?

Mar 7, 2011 2:21 PM

Elaine Moore :

Hi,
Ask your doctor to check you for thyroid antibodies. If you have them, lowering them with selenium and thyroid replacement hormone can help. see my new article on skin changes in autoimmune diseases and my article on ways to reduce thyroid antibodies.

If you don't have thyroid antibodies, watch for a new article I'm working on that describes a new blood test that tells what antibody is causing expression of the protein CD203c. This tells exactly what's causing urticaria, for instance pet dander or medication.

Mar 15, 2011 4:57 PM

Guest :

I have had a rash & hives for 2 1/2 months now. The only thing that relieves it temporarily is prednisone. I have been to a dermatologist and an allergist. I have taken Atarax, Allegra, Benedryl - together. Now, I'm on Singulair, Zantac and Zyrtec. I have had 3 skin biopsies and 1 scraping - all showing either hives or urticaria. I have had multiple blood tests and the only thing that has shown abnormal is an elevated ANA. All the other special send out tests have been within normal limits. I am to my wits end! I have been advised to go to the Mayo clinic because none of the specialists I have seen know how to treat me and don't know what to do.

Mar 15, 2011 11:52 PM

Elaine Moore :

Guest from 3/15/11
Since you have a positive ANA you might want to read the following article:
http://www.suite101.com/content/healing-the-skin-changes-that-accompany-a utoimmune-disorders-a356218
and also my article on dermatitis herpetiformis.
Also, there's a new blood test out that's only done at denver general that can help figure out if you're reacting to a specific allergen. I hope to write an article on it this month.

Apr 25, 2011 7:31 AM

Guest :

Hello,

I've only just discovered this site and its already been a big help. I have suffered with chronic urticaria for around 10 years now. I take Levocitirizine and montelukast daily to keep things in check, which for half the time is great. Recently my episodes seem to have become a little more regular and the angieodema appears anywhere and everywhere - more repeatedly on my feet, eyes, backside and hamstrings which can make walking, sitting etc.. very uncomfortable. I know that pressure is one of my triggers but I've never been able to pinpoint others such as foods because its never instant. If I have a cold etc.. It flares up quite badly too. I've also had two occassions over the last two years where I've had a bout of terrible 'gut ache' which the doctor identifies as a grumbling appendix and doubts there are any links. I feel that there must be something not right that if it could only be diagnosed correctly i'd be 'cured'. Do you recommend anything that I could do ? or any tests that I could specifically request from the doctor ? Any advice would be greatly recieved because sometimes I get a bit fed up of having to just carry on regardless.
Liam

Apr 25, 2011 2:16 PM

Elaine Moore :

Liam, low levels of C1Q contribute to angiodema so you definitely want this test as well as thyroid antibody tests. National Jewish in Denver also has a new blood test that will help tell if there's a specific allergen involved. See http://www.nationaljewish.org/pdf/Anti-FcER1_Antibody.pdf
There's also a link with helicobacter pylori that should be explored and can be associated with the gastrointestinal symptoms you mentioned.

Jun 26, 2011 4:14 PM

Guest :

I have autoimmune urticaria with angioedema. I am interested in your article about a new blood test that tells exactly what antibody is causing expression of the protein CD203c. I live in the Dallas area. Are any doctor's using this test in my area?

Jun 27, 2011 10:19 PM

Elaine Moore :

as far as I know, only national jewish is running this test. but a local lab can easily send your blood to be tested there, using NJ as a reference lab.

Jul 13, 2011 7:08 PM

Guest :

Ms Moore's suggestions have been very helpful. I have had chronic urticaria for over 8 months. I have kept the symptons at bay by taking 8000 mg of vitamin D, vitamin A, zyrtec and zantac twice a day.

I recently took the information about thyroid antibodies with me to my dr. Blood work was ordered and my TSH was 23 with abnormal readings in other areas as well. I am now scheduled for an endocronoligist. Thank you for your help.

Jul 20, 2011 5:52 AM

Guest :

34 year female. Have Hashimotos thyroiditis. In February of this year 2011 I started waking up with one of my eyes swollen. This has happened once a month since then. Does not respond to antihistamines, lasts 24 hours. During May episode I went to my dr. She ran some tests, and found out my c1 inhibitor level was low (13). All other complement levels are normal. Possibly Hereditary Angeoedema. Now under the care of an immunologist. Had complement tests run again in mid June,(in-between attacks). this time my levels were normal! have a standing order to have HAE test run again during next attack. I'm trying to find a cause of this. I started Cytomel in late winter and wondering if this could be a possible allergic reaction to that drug. I know c1inhibitor levels are not suppose to fluctuate, but mine do.

Aug 11, 2011 5:56 AM

Guest :

I made the comment on July 13. I didn't include I have been on increasing amounts of Synthroid. My PA recently increased it to 88 after my last blood test indicated my TSH had dropped, after raised from 50 to 75 for 6 weeks, but was still at 13. I also take the selenium.
I went to allergist last December, who ruled out food allergies. Lately, I have been having more breakouts, today's were more severe. I see the endo later today. Other autoimmune in family, my son has Vitaligo and diagnosed with Crohn's 3 years ago. We believe he had Crohn's since 2002.

Aug 21, 2011 5:44 AM

Guest :

Followup to Endo visit. - Eye opening. While I have been on increasing amounts of Synthroid. 25 - to now 100 after Endo visit, I have not been taking correctly. Take on empty stomach, NO other meds, vitamins, etc at the same time. Also, NO calcium, iron, or ant-acids for 4 hours. He said the way I was taking, was passing straight through. Diagnosis Hashimoto's, needed more dosage because of weight. Now I am taking as prescribed, still taking everything but Selenium, a few smaller hives. I am hoping those will start to disappear when I am on dosage longer and taking correctly.

Oct 26, 2011 1:16 PM

Guest :

HI Elaine,

I have a daughter who has just turned two. Over the last 6 months everytime she catches a cold or flu bug she breaks out in hives. Everytime this happens the out break is worse and lasts longer. She is averaging one about every 5 to 6 weeks lasting anywhere from five to ten days. After our last hospital visit 6 days ago I was told she had acute urticaria and to keep giving her Diphenhydramine( adult dosage) until it goes away. The doctor mentioned that it was probably due to an auto immune disorder but no futher tests have been done to confirm this. I am concerned as to the side effects of giving her such high doses of this medication over a long period of time. Do you know of any studies using this medication?

Thank You,
Colleen

Oct 29, 2011 12:44 PM

Elaine Moore :

Diphenhydramine used to be a prescription drug, but in around 1982 its status was changed to over-the-counter. It's generally considered to be a safe drug although it has its own side effects including drowsiness. It would be good if your daughter could have RAST tests or other more specific tests to tell what she's reacting to. Foods and medicines are the common causes. It would help to know the cause than to indefinitely take medications. for more information, see www.drugs.com/sfx/diphenhydramine-side-effects.html

Feb 25, 2012 11:16 AM

Guest :

Help! I was diagnosed with hypothyroidism approx. 12 yrs ago. Finally, got my dosage correct with Armour thyroid. I started the itching on my stomach the day after my last child was born. It hasnt stopped since. I have been itching for almost 2 yrs. now! I am a diabetic so the steriods help but send my blood sugars into outer space. I am taking so much allergy meds it isnt funny.. nothing helps! I have been scheduled to see an endo (waiting on a date). my thyroid levels are within "normal" range. However, my thyroid antibodies are 700(ish). any suggestions about stopping the burning, pin needles feeling all over my body besides benedrayl, zantac, atarax, claritin, clarinex, singular, allegra? Have anyone heard of issues using the armour thyroid. For a while Armour was off the market, I was taking the generic of synthroid and cytomel. But since I have never had a problem with the Armour before I went back on it. Any help is appreciated!

Feb 26, 2012 12:09 PM

Elaine Moore :

Hi,
Thyroid antibodies may be contributing to your rash. Selenium at 200-400 mcg daily can help lower thyroid antibodies, which would help. Doctors often prescribe more replacement hormone as well to help lower thyroid antibodies along with some of the meds you've mentioned. Further tests to help identify specific allergens would also help.

Mar 28, 2012 10:57 AM

Guest :

Hi Elaine, first of all sorry for my horrible English, but I write from Spain and while I understand, I speak pretty bad, so I translate with Google and I hope you understand something.
My name is Esther and for some months, 4 months, I am going through hell with a urticaria that is driving me crazy. I am patient with Hashimoto's thyroiditis from 11 years of age, now I´m 33 years old. My thyroid antibodies have always been very high.A few months ago, I had an accident in my hand, so my doctor recommended that I get vaccinated tetanus.In Spain is given along with diphtheria, so I start vaccination and development in the second dose an urticaria that begins with arms and means to pressure areas, elbows, buttocks, lower back, knees ... I was told I could be Arthus reaction, I had fever and I was dying! after time given me antihistamines, Spain Bilastine called, but the hives Ebastine ... goes on and on for days seems to be doing bigger.Analysis for lupus anti-DNA antibodies negative, ANA negative despite my thyroid problem ... negative analysis of parasites and also show only anti-TPO very high, since childhood I got them at 11,000 when normal is under 50 I think. Now desperate for this allergy, I begin to think that was allergic to tetanus shot ... I do testing of tetanus toxoid-specific IgE and positive ELISA test result tetanus toxoid IgE 2.59 kU / L normal range less than 0.2 but time passes and I think something else is behind the rash, stopped eating certain foods but did not improve and I think what else can influence ... I thought I could have an allergy to my thyroid medicine in Spain is Eutirox, I take 100 mcg of levothyroxine a day although I have no well-controlled hormones. My doctor says I have to up the dose to 125, but I begin to fear and if I have an allergy to levothyroxine? My doctor says it is almost impossible, but I do allergy testing to levothyroxine in vitro, TDBH, and appears positive result is detected in vitro hypersensitivity to levothyroxine. Result: 35%, normal range less than 30%. Now I'm still taking it! Because I don´t know what can I do.I need levothyroxine, but now I have allergies, what can I do? I keep mulling over my head with this problem. I take antihistamines while levothyroxine, but there are days I'm full, especially on back, belly, arms ... knees ... I also miss a corticosteroid ointment. Do not know what to do I try to switch brands or other additives allergy really exists levothyroxine? Need help please ... my wedding is in June and the stress is killing me!
Greetings from someone truly desperate.
Esther from Málaga, Spain.

Apr 18, 2012 1:35 PM

Elaine Moore :

Esther,
vaccinations stimulate your immune system and cause increased production of antibodies, including thyroid antibodies. Your high thyroid antibodies are likely the cause of your symptoms. Increasing your dose of thyroid replacement hormone is the best plan. some doctors also use zyrtec, zantac, and/or claritin. Using 200-400 mcg selenium daily can also help lower thyroid antibodies. see my articles on this. good luck, elaine

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