 Hi, this is Dr. Ruscio, and let's discuss a audience question about urticaria or hives. Let me read this question here from Maria. Hi, doctor. There's one topic that I've never heard any functional doctors talk about, and that is chronic urticaria. There is a very little known about what causes this condition and how to treat it effectively. Thanks. Sure. So, urticaria, also known as hives, there are different types of urticaria. There are different causes of urticaria. I would like to provide you with a few broad strokes in terms of simple and foundational things that I have found to be helpful. So, again, urticaria, hives, and some people will experience hives randomly. Some will experience hives from activity, from stress, from hot or cold exposure, from eating certain foods, and these all have different labels of heat induced, cold induced urticaria, contact urticaria, what have you. When we boil it all down, let's talk about what may be one of the predominant fundamental causes of urticaria and then what you can do about it. Now, again, there are many theories as to the cause of urticaria, but I think the one that holds the most promise and the most potential is the autoimmune component, meaning that urticaria might be autoimmune or it might be associated with the immune system and or other autoimmune conditions. So this is why we may see an increase of urticaria potentially in patients that have hypothyroidism. Luckily, though, speculation aside, what's nice about the autoimmune theory is that it gives us a lot to potentially work with or to modulate. And so there's two different angles that we can come at this through. One would be conventional medicine, one would be more integrative medicine. From an integrative perspective, there is definitely some promise in gut directed therapies because and probably no surprise that the gut has a fairly sizable impact on the immune system. Now this is likely why at least one study that I know of has found a higher prevalence of certain, using the term loosely infections in the intestines associated with urticaria and more importantly, treatment of those infections was shown to reduce the severity and duration of urticaria outbreaks. So this study in particular looked at various types of infections and again I use that term loosely because not all these things are technically infections but blastocystis hominins was the one found to be the most prevalent. Now blastocystis hominins is not considered an infection or a strict pathogen. Some circles consider it benign, some circles consider it pathogenic and I think the most reasonable approach is if you find blastocystis hominins in someone with symptoms to treat that. So we have some at least preliminary evidence showing the association and the causal link by treatment that blastocystis hominins and potentially other gut and balances may be involved with urticaria and may allow alleviation of urticaria. So that is very good news. Now there are other things that you can do which would be dietary changes. Dietary changes that help to improve gut health would also stand to reason to be able to benefit. There's a decent amount of animal evidence to support this. So something like a paleo diet or a standard elimination diet where you cut out foods that are oftentimes problematic for people seems to be a reasonable recommendation to make. There also may be aid garnered through the low-fob-mamp diet and the low-fob-mamp diet kind of transition us or transitions us into the topic of how more conventional medicine comes at this which is with histamine blocking agents H1 or H2, histamine 1, histamine 2, antagonists to try to block histamine which is part of the immune response and more so part of the allergy response using that term loosely. And remember that allergy and autoimmunity share this fundamental underpinning of the immune system status either either being a well-calibrated immune system or potentially an overzealous or mal-calibrated immune system. So conventional medicine typically administers various types of H1, H2, histamine, antagonists, histamine blockers and those can be effective. However, the low-fob-mamp diet has been shown to cause an eight-fold reduction in histamine according to one study. So a low-fob-mamp diet may do the same thing as these drugs and given they're over-the-counter drugs and fairly benign but it may achieve this from a dietary perspective. Now there's also the low-histamine diet specifically which could also be helpful which reduces dietary histamine. The low-fob-mamp diet deprives foods that feed bacteria that likely produce histamine and a low-histamine diet reduces the amount of actual histamine in food. So someone could even go as far as to go on a low-fob-mamp and low-histamine diet they really wanted to go at this aggressively. Now also treating any other gut infections could be helpful. Some of these histamine blockers could be helpful but all that together if you improve your diet either an elimination diet like a paleo diet or a low-fob-mamp or a low-histamine diet in addition to addressing any imbalances in the gut and this may be achieved by taking a probiotic. I don't know of any evidence showing that probiotics help with urticaria. It may be out there and just not aware of it but it would certainly stand the reason that if treatment of imbalances in the gut can improve urticaria and if probiotics help to improve the health of the gut then a probiotic may help with urticaria but it's speculative. But in any case by going through all these steps to optimize your diet optimize your gut health I think you have a fairly good probability of coming out with a good response to the urticaria. Now I'll also share in the post here one of our patients who had good results with urticaria and then also if you wanted to get really deep into this immune histamine angle a interview with Dr. Lawrence Affron who is a researcher essentially in histamine intolerance or as it's also termed mass activation syndrome. So there's definitely some very good options for urticaria and to Maria's point yes it's not something that you hear a lot about but for someone who's suffering with hives it can certainly be frustrating and maybe at times a little bit embarrassing and while there are some simple options of over-the-counter antihistamines there are also some more natural and fundamental treatments that may help you feel better. Now as a quick example if someone was to drive benefit for the urticaria from a low FODMAP diet there's a very good chance that they'll also see other improvements potentially they'll be less bloated they'll have better formed stools potentially less brain fog better energy or less irritability all these things can be achieved from rectifying the levels of histamine in your body one way of which you can do that is through a low FODMAP diet so again urticaria or hives is something that can be problematic but again Maria yes you're right there this is a condition that's not often talked about but fortunately there are some very helpful therapies that come back to this philosophy of starting with your gut and if you do that I think you have a good probability of coming on top so this is Dr. Ruscio and hopefully this information helps you get healthy and get back to your life thanks.