SIBO and hives are increasingly getting attention. I’m so very thankful for this, as I had SIBO and I now have chronic hives. Trading one terrible health issue for another is never fun. For the majority of the last two years I have been wading through hives with very little answers and zero real solutions. But over the last four months as I’ve found new doctors and the right researchers I’m learning more of the connections and finding helpful answers. I have been hesitant to write about hives because I feel like such a newbie, but where I have learned about the connections between SIBO and hives are through doctor appointments and conferences, so I want to share what I have learned so you have access to this information.
The Basics of Hives
Hives, also known as urticaria are raised bumps, or welts on the skin. Hives are pale-red or pink in color and often appear suddenly as a allergy response. Hives are itchy and range in size from pin-pricks, to bug bites, to giant “wheals” that cover large portions of the limbs or torso. Hives can appear anywhere on the body.
Hives are caused by the eruption of mast cells and histamine intolerance.
Mast Cells
Mast cells are a kind of white blood cell in our skin that erupt to bring attention to a specific area. Mast cells erupt as part of a response to bring added resources from other areas in the body releasing histamines and causing inflammation. For example, when we step off of a mountain trail and into a patch of poison ivy, the body responds to the irritant by triggering mast cells on the legs or wherever the poison ivy is touching to erupt, releasing histamines and causing hives. The pain and itching from the hives tells us to get out and back onto the trail immediately. Mast cells can erupt as an acute allergic response like the example of poison ivy, and mast cells can erupt from a Mast Cell Activation Disorder. Mast Cell Activation Disorders include a spectrum of immune disorders (most very uncommon) but do include autoimmunity and Mast Cell Activation Syndrome.
According to Wikipedia, “Mast Cell Activation Syndrome [or MCAS] is an immunological condition in which mast cells inappropriately and excessively release chemical mediators resulting in a range of chronic symptoms including anaphylaxis, cardiovascular, dermatological, gastrointestinal, neurological and respiratory problems.” Essentially, MCAS is an overreactive, hypersensitive response in which the body releases more histamines than it should through sensitive mast cells.
Additional Links for Mast Cell Activation Syndrome
Mast Cell Activation Syndrome: The Immune System Gone Wrong
Histamine Intolerance
Histamines are natural chemicals in the body released by mast cells and are also found and produced in the digestive system. Foods we eat contain histamines. Bacteria in our gut produces histamines. And some foods trigger histamines to be released. The body naturally keeps histamine levels in check by breaking them down or destroying them. The consumption, production, and release of histamines is a normal, daily part of biological function but when the pathways to destroy histamines become impaired intolerance forms. Histamine intolerance develops when the body cannot process the amount of histamines in the digestive system resulting in histamine absorption into the blood stream.
In order to regulate the amount of histamines in the gut and prevent histamines from entering the blood stream, the body has two different enzymes that degrade or break down food sourced histamines to keep the histamine load at a healthy level. The two enzymes are Diamine Oxidase or DAO and histamine N-methyl transferase or HNMT. DAO is much more active than HNMT in breaking down histamines in the gut. Humans are equipped to handle high levels of histamine. We should be able to detoxify food sourced histamine, but when we have overwhelmed the detoxification pathways of the body we are no longer able to process histamines properly and we start to see histamine overload symptoms like swelling and hives. (1) In a healthy body, DAO breaks down an estimated 99% of histamines in the gut before they reach the bloodstream. Click here to read more about DAO enzymes..
Histamines are found in foods. Most food have histamines and even the act of eating produces a histamine response in the body. But some foods have more histamines than others. Processed foods and fermented foods are extremely high in histamines. Foods like aged cheese, sauerkraut, pickles, aged meats, deli meats, vinegar, alcohol, chocolate, and leftover food are all high in histamines. Foods have several different classes in relation to histamines. Some foods contain histamines, some release histamines, and some foods are low in this natural chemical. Histamine releasing food is not high in histamines but allows the body, or microbiota in our body to release extra histamines, essentially causing a reaction within the body and increasing the histamine load.
Symptoms of Histamine Intolerance include:
- Rash, hives, eczema
- Headaches, migraines
- Low Blood Pressure
- Heartburn/ Increased Acid production
- Itchy or watery eyes
- Flushing
- Arrhythmia or irregular heart beat
- Wheezing
- Angioedema or swelling of the face, hands or lips
- Runny nose/Sinus Congestion
- Diarrhea
- Abdominal pain
- Flatulence
- Inflammation
If you pay attention to the last few symptoms, you can see they are also common SIBO symptoms. The line between symptoms caused by SIBO and symptoms caused by histamine intolerance can get blurry. Only a SIBO test can determine if SIBO is the cause of the GI symptoms or not. Histamine intolerance is also linked with gut issues like IBS and celiac disease.
Additional Links for Histamine Intolerance
Healing Histamines
High Histamine Food List
How To Tell If You Are Histamine Intolerant
Guide To Histamine Intolerance
How To Treat Histamine Intolerance
Histamine Intolerance- Could it be causing your symptoms?
Histamine and Histamine Intolerance
Contributing Factors to SIBO and Hives
Any gut dysbiosis that leads to damage along the intestinal track to the enterocytes and villi can lead to high histamine levels. DAO is located on the tips of the microvilli (ends of the vili) and damaged microvilli equals less DAO which means more histamines.
Small Intestine Bacterial Overgrowth itself can be a histamine producer. Bacteria in the large intestine naturally produce histamine and bacterial gases can cause a loss of DAO. More histamines with a lesser ability to break down the histamines can result in an overload and thus symptoms like hives.
This is likely (although not yet confirmed with studies) a result of the specific species of bacteria in the gut and in the overgrowth. In addition, there is evidence that the overgrowth blocks a good bacteria or treatments destroy a good bacteria that produces chemicals the body uses to control histamines. For example, the bacteria Lactobacillus rhamnosus or L. Rhamnosus produces a neurotransmitter called GABA, and GABA is linked to blocking histamine.
GABA or gamma-Aminobutyric Acid is the chief inhibitory neurotransmitter in the central nervous system and is believed to reduce histamine levels or to be a histamine suppressor. Bacteria such as L. Rhamnosus is a bacteria common to the human microbiome which produces GABA. If the body does not produce enough GABA on its own and does not have enough bacteria producing additional GABA then a high histamine response in the body may happen. Perhaps an overgrowth of SIBO reduces these GABA producing bacterias or treatments may wipe out this population enough that it no longer produces enough GABA to support the body. While GABA is studied for histamines, stress, and anxiety, GABA is not yet specifically studied in conjunction with SIBO. More information is needed.
We do know that with not enough GABA or inadequate amounts of histamine suppression, a hive reaction can occur. Read more about GABA Acting As A Chemical Break and Endogenous GABA Modulating Histamine Release.
In addition to bacteria and neurotransmitters is stress. Stress is increasingly linked to SIBO and hives. Doctors are seeing more and more patients with difficult SIBO cases develop hives, particularly those who choose to do the Elemental Diet as part of treatment. To be clear, not everyone who has SIBO will get hives and not everyone who does the Elemental Diet will get hives. I recently spoke with Heidi Turner with Food Logic about my own hives which started when I finished the Elemental Diet. She estimates that 5% of her SIBO patients who do the Elemental Diet develop a hive response after. The theory here is that during the Elemental Diet, the body calms down to the point where the nervous system can relax and move from the Sympathetic (fight or flight) to the Para-Sympathetic while it is not processing food and can take a break from fighting the SIBO. Upon returning to food, the body shifts too abruptly back into the Sympathetic nervous system and freaks out leading to Mast Cell Activation Syndrome or Chronic Urticaria. (2)
Several leading SIBO physicians say that Mast Cell Activation Syndrome (MCAS) is a result of the extreme stress both SIBO and SIBO treatment place on our bodies. Dr. Michael Ruscio at drruscio.com spoke about the strong connection between stress, MCAS, and SIBO at the 2017 Integrative SIBO Conference in February. He particularly noted that SIBO patients have extremely high stress levels when they seek help or treatment. And why wouldn’t we? SIBO is painful, can feel so scary with awkward, weird symptoms, and many times we’ve been told it is all in our head because it is a newer diagnosis. SIBO patients often look “healthy” even though we feel bloated and starved at the same time. Not to mention, healing protocols with strict diets, expensive treatments, and copious amounts of time consuming symptoms… It is no wonder SIBO is extremely stressful.
But stress from SIBO is not just from symptoms and treatments. Stress from SIBO can also be from microbiome imbalances. Summer Bock who specializes in healing the gut has a great article on how stress and bacteria are connected. Summer states, “Bad bacteria and yeasts secrete toxic chemicals that disrupt the nervous system and make you feel crummy, confused, anxious, depressed, and tired.” And, good “bacteria produce serotonin, GABA, and dopamine to communicate with the nervous system using the gut-brain axis. GABA calms the nervous system. Serotonin regulates moods and is used for peristalsis, the squeezing that pushes food through the gastrointestinal tract. Dopamine regulates reward-motivated behavior. These neurotransmitters relay messages into the brain just like text messages, telling our body what to do and letting it know what’s going on.” But with improper communication and increased bacteria causing neurotransmitter imbalances anxiety and stress are easily acquired.
Bacteria in the gut and stress are most commonly linked to hives. Stress will often even call the Small Intestine Bacterial Overgrowth back.
On top of neurotransmitters, bacteria, stress, and treatments are SIBO diets. Most SIBO diets are high in histamines. Bone broth cooked for hours is great for healing the gut but is high in histamines. Nuts, and aged cheeses are high in histamines and leftover foods develop histamines the longer they sit. Meat can also be saturated in histamines especially if it is canned, cooked for long periods, not fresh, or not eaten right away. But not all hives are caused by SIBO. Even if you have SIBO there could be other factors causing or contributing to hives.
In addition to hives related to SIBO and good bacteria are pathogenic infections like parasites. Parasitic infections like Giardia are known to cause hives.
Hormones and Adrenal Glands can also play a huge role in chronic hives. Hives triggered by hormones are usually estrogen dominant, and are often seen during para-menopause and pregnancy. Adrenal fatigue is also linked to hives. If you notice hives increasing or decreasing during specific times of the day or during menstruation cycles, or during aging, hormones or adrenal glands may play a role. Click here and here to read more about adrenal fatigue and histamines.
Lastly, there are the most commonly known triggers of hives like food allergies and environment. Food allergies are one of the most obvious connections to hives. Molds, pollens, dander, and chemicals all exist in the environments we live in and can trigger histamine responses on their own. When histamine levels are already high, these can have a powerful impact on increasing hives. Histamines in food and environment can add to a boiling pot effect by increasing the histamine load the body needs to process. The more factors contributing to hives and MCAS the more likely symptoms will present.
Tests to consider for SIBO and Hives
If you have chronic hives some tests to consider are:
- SIBO breath test if SIBO or gut dysbiosis is suspected.
- IBS Check Test for IBS – A positive IBS test is closely liked with SIBO, and shows an autoimmune component to SIBO and IBS symptoms. This can help guide healing protocols.
- Stool Testing- stool tests will show bacteria, parasites, fungi, and other pathogens in the colon and gut.
- Hormone Testing and Adrenal Testing – Hormone and adrenal testing can be helpful to rule out hive reactions, especially if you notice hives increasing or decreasing during specific times of the day or during menstruation cycles, or during aging.
- Food allergy testing. ALCAT Test is my favorite for food sensitivities and chemicals. MRT is also good and less expensive but is not as extensive.
Additional Resources
If you have any good resources specifically connecting SIBO and hives, please leave a comment with a sentence summary and a link to the resources.
References
(1) 2017 Integrative SIBO Conference Dr. Nirala Jacobi lecture http://www.synergycmegroup.com/2017-integrative-sibo-conference
(2) 2017 Phone consult with Heidi Turner of Food Logic
(3) 2017 Integrative SIBO Conference Dr. Michael Ruscio at drruscio.com
Shelby says
Hi Elena,
Thanks so much for sharing this! I also had really bad hives after finishing the Elemental Diet to treat my SIBO. Although the hives eventually cleared up, the SIBO came back. I’m now in the middle of my second Elemental Diet and have been experiencing odd rashes and welts on my skin throughout.
I didn’t know that these could be related and will definitely talk to my ND about it further. Thanks again for taking the time to share 🙂
Alvin says
Shelby i also have hives post ed. How long did it rwke for yours to go away
Juliet says
AT LAST someone has revealed to me a connection between SIBO and my lip swellings (hives), a connection I’ve been suspecting, but which no amount of expensive doctors have come up with. Or believe. Thanks so so much. From here I can move forward with hope!
Karin Østerby says
Hi Elena, I have sibo and started having chronic hives 10 months ago on a daily bases. It is really interesting your article. I will try out the DAO supplement but i cant figure out if it is good or bad to take Lactobacillus rhamnusus supplement when you have bacteraovergrowth?
Best regards Karin
Elena Wistey says
Hi Karin, You can absolutely try probiotics while you have SIBO. Most SIBO doctors use probiotics during different phases of treatment. Sometimes probiotics can crowd out offending SIBO bacteria and help reduce symptoms. Each person will respond to each strain differently. It is always best to start in VERY small doses and slowly work up as tolerated. Probiotics have been the number one help for me in healing my hives, and I too take L. Rhamnosus. Just start slow!
MIssy Maiorano says
Just wanted to check in and see how the hives are doing? I am in the same boat only starting much later than you. I’d love to know your strategies and timetable.
: )
Thank you!!
Elena Wistey says
Hi Missy!
I have had hives for three years. My doctors said 1-2 years in order for my body to calm down and the hives to go away, but my body has been a little slower. Over the last year my hives have been VERY minimal. When I do get them now, they are small, not very irritating and they go away within hours (instead of being 24/7 constant and feeling like I want to tear off my skin).
The biggest help for me was working on calming my immune system and nervous system, keeping stress to a minimum, sticking to a low histamine diet (can be tricky in conjunction with a SIBO diet), drinking a lot of fresh green juice, B-vitamins, eating LOTS of fresh fish, probiotics, and getting really good rest.
Everyone is different, so my timetable might be way longer than yours- remember I was super sick for many, many years so I have had a lot to undo/redo.
I hope this helps.
Elena
MIssy Maiorano says
Wow! I just saw this reply and I am so happy to hear that you are doing better! Yay! I am working on my SIBO and on my nervous system/stress level now. I really think, for me, the key is stress reduction, getting sleep, and rewiring my brain for peace and calm. I tend to be very tightly wound and Type-A. I am so grateful for you article and your reply. 🙂
Angie says
Hello, I know this is old but do you still have hives? I’m miserable with them.
Elena Wistey says
Hi Angie,
I’m so sorry to hear you are miserable with hives. I still get hives when they are triggered by specific things, but I no longer live with them chronically.
I think the Body Ecology Diet is incredibly helpful for restoring balance to the body. Much of the diet is SIBO friendly. There are a lot of rules to the diet but the principles of it seem to make a huge difference even if you can’t follow it exactly.
Have you tried things like dandelion tea, or milk thistle to help your body flush out the histamines?
Elena
Brett says
Hi after I finished with my anti microbial I started to get cholinergic urticaria. Basically hives from a rise in body temperature. Can anyone else relate to this or know what I can do? I believe it 100% is because of the anti microbial that I was on during treatment which was over 6 months ago. I have been taking l glutamine probiotics and dao for a few weeks now. Will my body every heal from this? I believe I cured my sibo back in august but now I deal with this regularly.
Ash says
Thanks for creating this site, Elena! I too have been experiencing hives and immediately assumed it was from my SIBO. Unfortunately I have both types which has been extensively hard to treat. To be honest, I’ve nearly given up because nothing has helped. I’m not sure what the triggers are- if it’s possibly for related at times, but Brett, I am also convinced it’s when my body temp increases also! My first encounter was after working out and have since noticed even a walk with my dog gives me random hive/hives on my legs. The doctors I’m working with aren’t very knowledgeable so I’ve basically been taking Reactine as necessary and washing the skin surface. Otherwise I’m at a loss of what to do but dealing with this for 2 years now (hives are newly onset), is exhausting! 😕
Ash says
*food related items