Case Study - Pippa’s Hives
Pippa* is a 24 year old woman who came to see me recently. She’d been suffering hives for more than a year – and every time she experienced a flare her whole body would itch for anywhere from 2 hours to 2 days. Almost every part of her body was affected, from her face and neck to the soles of her feet on some occasions. She had taken some photos of her skin during an outbreak (not pictured) and it was obvious to me that her condition was not only uncomfortable but also interfering with her ability to fully enjoy her life. Her doctor had suggested that she monitor her condition for a couple of months, take antihistamines when necessary (which weren’t really doing much to relieve her symptoms) and book in to see an allergist if things didn’t settle down after this time. Pippa had found it difficult to find an available appointment with an allergist, so decided to come see me in the meantime.
Pippa had cut out gluten from her diet a few months after the hives first began, and while she did notice that her hives improved somewhat, she was still experiencing the flares and after a while they had been starting to worsen again. She had also been experiencing bloating in her gut which settled down after removing gluten from her diet.
What Was Wrong…
Histamine is an inflammatory molecule produced naturally by the immune system, and when it is present in excessive amounts it can contribute to itching, hives, wheezing, sneezing, and it may even play a role in seemingly unrelated issues such as migraines and hormonal imbalances like PMS. Naturopaths call this 'histamine intolerance' (however, it is not a medically recognized condition). Histamine is also naturally present in many foods – even healthy ones such as spinach, tomatoes, bone broth and fermented foods.
Histamine relies on an enzyme in the gut to break it down and eliminate it from the body properly – and when someone’s gut and immune system are in balance this usually isn’t a problem. However, what can happen if this pathway (the diamine oxidase enzyme, or DAO for short) is not functioning properly is that the system can quickly become overloaded – either by too many high-histamine foods in the diet and/or the body’s own production of histamine. Whilst the symptoms of histamine intolerance can be significant, the good news is that it is usually only a temporary situation that may be improved with the correct approach. I suggested that she try my Soothe & Settle Program for Reactivity and Intolerance, which would approach her issues from two different directions.
What We Worked On…
The first part of Pippa’s program was a temporary dietary strategy called a low-histamine diet. We focused on reducing any sources of foods that were high in histamine, in order to take a load off the gut and allow it to have a chance to re-establish the proper enzymatic pathway. After the initial elimination phase, we were able to begin systematically re-introducing certain high-histamine foods to ‘test’ them for reactions – one at a time. This allowed Pippa’s system to continue to have the opportunity to heal and re-establish balance. While we were focusing on this part of Pippa’s program, I also had her start on some targeted supplements to build her gut and microbiome health, as 70% of the immune system is located in the gut, and this is a major area that is involved in reactivity. This two-pronged approach ensured that not only were we reducing the load on Pippa’s immune and digestive systems, we were also actively working towards restoring balance to her immune system in order to improve her immune tolerance.
Pippa’s results were nothing short of dramatic when I saw her a fortnight after her initial appointment. She stopped experiencing hives outbreaks almost immediately – apart from one isolated incident involving her feet, which she put down to some poorly fitting dance shoes. She also made the comment that she felt ‘lighter in the tummy’ and her digestion just felt better after following the diet and taking the supplements I’d prescribed.
It has now been just over a month since I first started working with Pippa, and at her most recent appointment she still hadn’t experienced any further hives outbreaks. She had moved into the rechallenge phase of her program, where she was quite happy to progress through the few weeks of ‘testing’ certain high-histamine foods, and so far she has not noticed any reactions. This has meant that she has been able to add back in some of the foods that were likely contributing to her hives prior to her treatment. She’s now down to 1 key supplement to help continue the gut support aspect of her program, and because she has been doing so well we have revised the length of her Soothe & Settle Program down to 8 weeks in total, from the 12 weeks I originally allocated. Needless to say, Pippa is very happy with her progress – as am I!
*Name changed for privacy reasons