Can Stress Cause Hives? The Answer is Complicated

Curated by Claudia Shannon / Research Scientist / ishonest

Stress Can Make Hives Worse in Those Who Are Already Prone to Getting Them

“For most individuals, stress isn’t an independent risk factor for hives — or else wouldn’t we all have hives?” says Adam Friedman, MD, a professor of dermatology at the George Washington University School of Medicine & Health Sciences in Washington, DC.

For instance, there is some evidence that hives may affect women more than men. (1) Hives are also more common in people with autoimmune diseases. (2) And hives also tend to be common in people who have other allergic reactions, too — and when they do, stress can make those hives worse.

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If you fall into one of those groups, stress may trigger hives. But for other individuals stress alone may not be enough to trigger hives.

There is one form of chronic hives, cholinergic urticaria (wherein the hives are triggered by elevated body temperature), in which emotional stress can induce the rash, says Anthony M. Rossi, MD, an assistant attending dermatologist at Memorial Sloan Kettering Cancer Center in New York City. And that condition tends to be more common in people with conditions like asthma, eczema, and allergic rhinitis.

Stress may influence hives in another way, too, if that stress causes you to pick or scratch your skin (which is a common habit, Dr. Friedman says). Friction or pressure on the skin is a risk factor for hives, and the act of scratching that skin can cause the release of the chemical histamine, he says. When that happens, your body reacts by producing a hive.

Another mechanism by which stress affects hives is in people who have a condition called dermatographia, Dr. Rossi says. When people who have this condition scratch their skin, even lightly, those scratches result in a raised welt that looks like a hive. The skin has erroneously released histamine because it’s not been triggered by a response from the body’s immune system, but rather by an external stimulus, like exercise, heat, stress, vibration, or exposure to the cold. (3)

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Doctors aren’t entirely sure what causes this condition, but it's estimated to affect 2 to 5 percent of the population. (3)

The Symptoms That Stress Can Bring on

Emotional stress can prompt these long- and short-term symptoms.

Living With Hives Can Certainly Contribute to Stress

Whether or not stress contributes to hives, the opposite is certainly true: Hives can add a significant amount of stress to people who are prone to them.

“When somebody has chronic hives, the effect on their mental health and well- being can be dramatic,” says Sarina Elmariah, MD, PhD, a board-certified dermatologist at Massachusetts General Hospital in Boston. Because that person knows he may be uncomfortable and scratching himself — scratching is a reflex, and if your skin is itching, you’ll scratch it, Dr. Elmariah adds — that person might avoid certain social situations.

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You often don’t sleep well as a result of feeling discomfort like this, which can cause irritability and fatigue. “At that point, it becomes a real challenge not only for patients, but often their families who have to learn to deal with the dynamics of somebody who’s chronically uncomfortable,” Elmariah says. This dynamic can create more challenges at home and in the workplace.

Why Exercise and Sleep Are Your Ultimate Defense Against Stress

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Treating Chronic Idiopathic Hives

Various medications have been designed to block the immune response that causes hives. Learn about your treatment options.

Living With Chronic Hives: Sierra’s Story

Chronic hives are unpredictable, and symptoms can come and go for years. One New Yorker knows this all too well, and she's found ways to cope.

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