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 up to 2 days. Almost every part of her body was affected - from her face and neck, and even the soles of her feet on some occasions. She showed me some photos she had taken of her skin during an outbreak, and it was obvious to me that her condition was not only uncomfortable but also interfering with her ability to fully enjoy life.
Unfortunately, Pippa's doctor did not have any advice other than to simply 'keep an eye on things' for a couple of months, take antihistamines when necessary (which were only offering very minor relief) and book in to see an allergy specialist if things didn’t settle down on their own. The earliest available appointment with the specialist was months away, so she decided to come see me in the meantime and see if I could help.
Pippa had been trying to work out what might be triggering the outbreaks, and had already cut out gluten from her diet a few months after the hives first began. Whilst 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 even without gluten as a trigger. She had also been experiencing digestive discomfort and bloating after eating certain foods.
What Was Wrong…
When we started chatting about Pippa's experience, it seemed obvious to me that histamine was playing a central role. Histamine is an inflammatory molecule produced naturally by the immune system, and when it is released in response to a trigger it can cause itching, hives, wheezing and sneezing. Even seemingly unrelated issues that we wouldn't associate with an allergy - such as migraines, anxiety and hormonal imbalances such as PMS - can involve histamine. Histamine is also naturally present in many foods – even healthy ones such as spinach, tomatoes, bone broth, leftover home-cooked foods and fermented foods - and this can contribute to the histamine load within the body in sensitive individuals.
Our body needs to process and eliminate histamine once it has served its purpose, and for this it needs an enzyme known as diamine oxidase enzyme (or DAO). When someone’s gut and immune system are in balance this usually isn’t a problem - the body is able to 'mop up' any excess histamine once the reaction has subsided. However, what can happen if this pathway is not functioning properly is that the system can quickly become overloaded with histamine – either by too many high-histamine foods in the diet and/or the body’s own production of histamine. This situation where there is too much histamine floating around is known as 'histamine intolerance'. Whilst the symptoms of histamine intolerance can be significant (and uncomfortable!), the good news is that it is usually only a temporary situation that may be improved with the correct approach.
What We Worked On…
The first part of Pippa’s treatment plan consisted of some initial tweaks to her food choices to reduce the histamine load coming into the body. We focused on avoiding 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.
Results
Pippa’s results were nothing short of dramatic when I saw her a fortnight after her initial appointment. The outbreaks had stopped almost immediately. 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.
After a month of working with Pippa, I checked in to see how she was going and she still hadn’t experienced any further hives outbreaks. She was continuing to progress through a further few weeks of ‘testing’ certain high-histamine foods, and had not noticed any reactions or any flares. This has meant that she was able to safely add back in some of the foods that were likely a trigger for her hives prior to her treatment. We were also able to reduce her supplement regime down to 1 key supplement to help continue supporting her gut health.
Needless to say, Pippa was very happy with her progress – as was I!
*Name changed for privacy