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Q&A with Australian Health Practitioners
What is causing my chronic hives, angioedema and anaphylaxis?
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I am a 23-year-old female with no history or family history of allergies, chronic hives or angioedema.
2 months ago I started to break out in hives all over my body and am taking medications to control it. I have had 2 episodes of anaphylaxis and angioedema, the second time was very severe as my lips, cheeks and eyes swelled up to 4x their usual size and I felt dizzy, faint and passed out and couldn't breathe. The only thing these episodes have in common is that they were both exactly one month apart and on the very first day of my menstrual cycle.
Skin prick tests came back negative. I have antibodies targeting my thyroid gland (I think the number was 600). My TSH is 2.3 which is good. Other symptoms are fatigue, dizziness (haematinics in normal ranges), hair loss, joint pain in my knees, knuckles and wrists when hives flare up, feeling hot and getting shivers.
Could it have anything to do with catamenial anaphylaxis? -
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Dr Liam Beiglari
Allergy Specialist & Immunologist
I am a clinical immunologist and allergist. I am experienced in the diagnosis and treatment of adult patients with allergic diseases, autoimmune conditions, those living … View Profile
Your symptoms certainly sound consistent with chronic spontaneous urticaria, especially with recurrent hives and angioedema. Angioedema is common in this condition. However, episodes involving dizziness, fainting, breathing difficulty, or collapse need to be treated as possible anaphylaxis, so it is important that you carry an adrenaline autoinjector and have been taught when and how to use it.
Thyroid autoantibodies are seen more commonly in people with chronic spontaneous urticaria. They do not necessarily mean the thyroid is causing the hives, especially if the TSH is normal, but they can support the idea that there is an autoimmune tendency.
The timing with the first day of the menstrual cycle is worth mentioning to your specialist. Catamenial anaphylaxis or hormone-related urticaria/angioedema is rare.
The broader symptoms you mention, including fatigue, dizziness, hair loss, joint pains, feeling hot, shivers, and fevers, deserve further assessment. They raise the question of whether something else is contributing, such as an autoimmune or inflammatory condition. Conditions such as urticarial vasculitis or systemic autoimmune disease can sometimes mimic or overlap with chronic urticaria.
Overall, I would suggest making sure the hives are treated properly, usually starting with regular non-sedating antihistamines under medical guidance, ensuring you have an anaphylaxis plan and adrenaline autoinjector, and seeing a clinical immunologist/allergist, and possibly a rheumatologist, to look for an underlying cause.
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