Earlier this month, Vice President and presidential nominee Kamala Harris released a report with details about her health and medical history from her White House physician Dr. Joshua R. Simmons, reflecting a physical taken in April. Simmons deemed her to be “a healthy 59-year-old female who has a medical history notable for seasonal allergies and urticaria.”
The report noted that she’s been treating her urticaria, commonly known as hives, with “allergen immunotherapy (AIT) for the past three years.”
The skin condition causes raised, itchy, red welts that resemble blotches or bumps. They can occur anywhere on the body, and can be as small as the head of a pin or as large as a dinner plate. They often appear on the surface of the skin but can also form inside the nose and mouth.
While urticaria is common, hormonal fluctuations during perimenopause and menopause can trigger or worsen urticaria in women over 30, but it is treatable and easy to keep under control.
“It affects approximately 25% of people at some point in their lives,” Dr. Mario Lacouture, chief of dermatology at NYU Langone Hospital – Long Island, tells Flow Space. “At any given time, about 1% of the population has chronic urticaria, which lasts more than six weeks.”
Who is most likely to develop urticaria?
While urticaria can affect anyone, there are certain patterns doctors see in patients with the condition. Lacouture says women are affected at nearly double the rate men are, and it is more common in women ages 30 to 50 than any other adult age group.
Children under the age of five have the highest incidence rate of urticaria, and Black people are four to five times more likely to develop the condition than white people.
Genetics can also play a role. People who have a family history of urticaria are more likely to develop it, as are people with a history of allergies or autoimmune conditions.
What can trigger urticaria?
Urticaria can be caused by a variety of factors, but in about 90% of chronic cases, no specific trigger can be identified, says Lacouture. However, there are specific stimulants that can aggravate or bring it on.
They include:
- Foods, particularly shellfish, nuts, eggs and milk
- Medications that include, NSAIDs, aspirin and antibiotics
- Insect stings or bites
- Physical stimuli like pressure, cold, heat or intense exercise
- Environmental allergens like pollen
- Tight clothing
- Bacterial infections, including urinary tract infections and strep throat
- Viral infections, including the common cold
While stress is rarely the cause of urticaria, it can make symptoms worse. Skin care can also trigger the onset of the skin condition if you introduce something new into your routine that your body does not like.
What are the best treatment options for urticaria?
Treatment options for urticaria depend on the type of urticaria and the severity of symptoms.
“Treatment typically follows a stepwise approach,” Lacouture explains. “The first-line is usually a second-generation H1 antihistamine (such as Zyrtec, Claritin or Allegra). If that provides an inadequate response, we would try an increased dosing of antihistamines—up to 4x standard dose—adding H2 antihistamines, omalizumab for chronic cases, or a short-course of oral corticosteroids for severe flares.”
If brought on by environmental or food triggers, most cases improve within just a few minutes, but some can last up to a few days or may come and go for days or weeks. In some cases, hives can go away on their own but oftentimes need some form of medical treatment.
If you’re finding that you’re developing hives more frequently, you can keep a diary for your doctor to review that includes where your hives appeared, what foods you ate around the time they appeared, what you were doing and if you introduced any new products into your daily routine.
What women in menopause should know about urticaria
Because women are twice as likely to develop urticaria, and women over 30 are more susceptible to the condition, menopause is a prime time for the chronic condition to appear.
The emotional and physical stress during this life transition can exacerbate symptoms, and hot flashes or night sweats can trigger heat-induced urticaria.
Estrogen levels decrease during menopause, which can trigger an autoimmune response that leads to hives, and it can also increase histamine levels in the body
While there is very little scientific research on the connection between menopause and chronic urticaria, one study in 2008 stated that “urticaria may be associated with some diseases and conditions characterized by hormonal changes.”
“Hormone replacement therapy may affect urticaria symptoms in some women,” Lacouture adds. “Autoimmune conditions, which are more common in menopausal women, can be associated with chronic urticaria as well.”