Can stress make chronic hives worse?

Stress is a normal response by the body, a sudden release of hormones like cortisol and adrenaline that give a person a boost of energy and focus that enables them to react quickly. If you have ever jumped at a scary moment in a movie or faced an oncoming opponent in a sports game, you have experienced a stress response. More specifically, you have experienced acute (short-term) stress.

When stress lasts a prolonged period of time it is referred to as chronic stress. High-pressure jobs, financial hardship, and caregiving are all common examples of situations that can lead to chronic stress.

Chronic stress has been associated with the onset and worsening of many different health conditions, including chronic spontaneous urticaria (CSU), formerly known as chronic idiopathic urticaria and sometimes referred to as chronic hives.

Chronic spontaneous urticaria (CSU)

CSU is a condition that causes recurring episodes of skin inflammation. Most often, this manifests as hives or wheals, itchy raised welts on the surface of the skin. Many people with CSU also experience angioedema, inflammation in the deeper layers of the skin. These symptoms occur on most days of the week for at least six weeks—but may occur more frequently, and for longer periods of time.

One of the defining characteristics of CSU is a lack of identifiable triggers. Symptoms cannot be induced by exposure to specific triggers, though some episodes may be linked to events, environments, and other factors.

Are chronic stress and CSU connected?

Stressful life events have been associated with the onset of CSU in many cases. For some people living with CSU, stress may make symptoms worse. The connection between stress and CSU is not fully understood, but it has to do with the way that prolonged periods of high stress can disrupt how the immune system works.

While the mechanisms are complex, the basic idea is that stress activates certain inflammatory cells—including inflammatory cells in the skin. Chronic stress can contribute to chronic inflammation, where inflammatory cells stay activated for long periods of time. In the case of CSU, inflammation manifests as hives and/or angioedema.

Keep in mind that this is a very simplified explanation. Also keep in mind that while stress may be a contributing factor to some cases of CSU, it is not the only contributing factor. CSU is a complex condition, and the causes are not fully understood.

Living with CSU can be stressful

While it helps to understand how stress can affect CSU, it is also important to acknowledge how having CSU can affect a person’s stress levels. Itch, sleep disturbances, healthcare costs, the unpredictability of symptoms, and may other aspects of living with CSU can cause psychological distress and frustration. In some cases, this can contribute to anxiety disorders, which are more prevalent among people living with CSU (compared to people who do not have CSU).

There’s also the fact that being stressed can make anything more difficult. This includes managing a health condition. It can be easy to forget to take a medication when you haven’t gotten enough sleep. If you’ve tried a few treatments that haven’t helped your symptoms, it may be more difficult to find the energy to sit down with your healthcare provider and figure out what comes next. While these are just examples, they demonstrate how stress might affect treatment for CSU.

Strategies for reducing stress

While there is a need for more research on the subject of CSU and stress, reducing stress can contribute to better mental health, physical health, and quality of life. Here are some strategies that may help.

• Discuss your stress levels with your healthcare provider. Also discuss your moods, sleep schedule, and overall wellbeing.
• Make time for the things you enjoy and that are important to you, even if it’s just a few minutes each day.
• Avoid unhealthy habits like alcohol consumption, tobacco, and recreational drugs.
• Try relaxation techniques, such as meditation or deep breathing exercises.
• An overall healthy lifestyle—with a balanced diet and regular exercise—can help lower stress levels and boost mental health. Remember, it’s always a good idea to talk to a healthcare provider before starting an exercise program or changing your diet.

Also, do not underestimate the impact that CSU can have on mental health. Consider new methods of coping with CSU, such as participating in a support group or working with a provider that specializes in mental health.