Can Stress Cause Hives?

Stress can cause a lot of weird things to happen in your body. The experience of emotional stress can trigger hair loss, mess up your bowel habits, and even make your eyes twitch. Can it cause your hives, too? There’s definitely a connection between emotional stress and hives, but experts say stress may be blamed as a bigger culprit when it comes to hives than is actually the case.

“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 and chair of dermatology at the George Washington University School of Medicine & Health Sciences in Washington, DC.

It’s much more likely that stress plays a role in the development of hives in those who are already susceptible to getting hives, he adds.

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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.

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 not because it’s 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)

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

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.

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.

The first step in managing stress-related hives is taking steps to help manage stress, so stress isn’t triggering the reaction in the first place.

Managing stress is easier said than done, of course. While there is not much data on stress-relieving activities that might specifically help hives, there is evidence that things like yoga, meditation, and exercise can help people with psoriasis, and there’s evidence those stress-relieving activities can help with eczema, too.

“And if those activities can help those skin conditions, it’s safe to assume they may also help with hives, too,” Friedman says.

Other scientifically proven ways to relieve stress include getting enough sleep, eating a healthy diet, maintaining a strong social network and work-life balance, adopting an attitude of gratitude, embracing spirituality, thinking positively, and smiling.

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If you’re suffering from dermatographism, medications — an oral antihistamine, like cetirizine (Zyrtec) or fexofenadine (Allegra) — can help, Elmariah says. They won’t cure you, but they can help relieve the itch.

Some people benefit from avoiding wool, irritating chemicals and fragrances, harsh soaps, and by using emollients to hydrate the skin.

If stress is contributing to hives for you, then controlling stress can help. Not only does managing stress lessen the frequency or severity of hives, but you’ll also reap all the other physical, mental, and emotional benefits of coping well with the stress you face, Elmariah says.

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