Urticaria and Other Skin Conditions with Fibromyalgia

Urticaria is the medical term for a very common condition known as hives. Hives are not typically dangerous, however when angioedema, which is a swelling under the surface of the skin, occurs, it can be problematic. Hives and angioedema can be found on all parts of the skin including inside of the mouth, on the tongue and in the respiratory tract. Hives are most commonly found on the surface of the skin and, although they are painful and irritating, they are not in themselves a major health concern for otherwise healthy individuals. For people with fibromyalgia that are already in an immune stress situation, hives can pose additional problems and complications.

Urticaria can be chronic, which typically means that the hives have been present for at least six weeks. When hives are present for less than six weeks, they are often the result of an allergic reaction and this condition is known as acute urticaria. In both chronic and acute (long term or immediate) urticaria the symptoms are the same. They include red, raised bumps, itching, burning and painful areas of the skin

The Causes of Hives

There really is no clear understanding of why chronic urticaria is so common in people with fibromyalgia. There is new research that suggests that a dysfunction in the skin level nerve fibers may be to blame. In fact, in a study completed in Italy, 70% of people with chronic urticaria also met the criteria for the diagnosis of fibromyalgia. 1

The development of hives is really a bit of a mystery in most people. While they can be a result of an allergic reaction to a specific known substance, they can also appear suddenly without the person having a history of allergic reactions. In acute urticaria with an allergen as the trigger the wheals, which are raised skin areas that are typically red in color and swollen, may appear within a few minutes to a few hours of contact with the allergen. Allergens can include substances that touch the skin or foods or medications that are taken internally.

For some people contact with the skin can actually cause wheals, as can heat, exposure to the sun, exercising followed by sudden exposure to the cold, and even contact with water, which is very rare. There is as inherited form of urticaria as well as an acquired form.

The vast majority of people with fibromyalgia that also have hives will have a type of urticaria known as cholinergic urticaria, which means they are stress induced. This type of stress can be physical stress, such as exercising, or any type of mental stress that changes the body’s parasympathetic nervous system response. One very rare yet applicable type of hives is related to the body’s reaction to the production of adrenaline and noradrenaline. Since changes in the HPA axis (hypothalamic-pituitary-adrenal), which controls adrenaline and noradrenaline production in the body, is seen in people with fibromyalgia it is a cause worth considering if other causes are ruled out.

Medications can also be directly related to the development of hives. Some of these medications may be used by people with fibromyalgia including the common over the counter drugs aspirin and ibuprofen.

Finally, and perhaps the most relevant for fibromyalgia patients, is the role that stress plays as a cause of hives. Clear associations between the development of urticaria and posttraumatic stress syndrome, as well as depression and sudden and traumatic life events, are well documented. In fact, in a study of patients that had chronic urticaria, it was found that thirty four percent also had posttraumatic stress disorder (PTSD). In addition adverse life event stress, perceived high stress and other psychiatric symptoms were also present in these participants in the study. 2

Consequences of Chronic Urticaria

Hives, although very common in the general population, are still problematic for anyone that has this type of skin condition. The raised, red wheals are noticeable and the burning and itching adds to discomfort and the difficulty of having to explain the condition to everyone that you meet. Add to this the fact that hives are often found on the neck, hands, arms, face and legs and you have a definite problem with feeling good about your appearance. This, in turn, tends to lower your quality of life.

Chronic urticaria can result in increasing fatigue, increasing medical costs and a feeling of the need to be socially isolated. 3 In addition the stress of having the condition, which can last for years in chronic cases, is particularly devastating.

Treatment Options

For people with fibromyalgia the cause of urticaria is often idiopathic, which means there is no known cause of the condition. This may indicate that it is linked to stress or to the hormonal and chemical changes in the body due to the fibromyalgia itself.  While it may seem overly obvious to talk about stress reduction, this really can be an instrumental component in treating and controlling the outbreak of hives.

Relaxation exercises, including yoga, may be very beneficial in relaxing the body and mind and also in reducing stress. Progressive relaxation which tends to reduce muscle tension combined with deep breathing may help some individuals in lowering stress levels and also in helping reduce the chronic pain. As pain levels decrease so does the physical stress and, in turn, mental stress.

Careful control of the diet may also play a role in treatment or management of urticaria if dietary allergies or sensitivities are present. For many individuals a group of molecules known as excitotoxins may change the way that neurotransmitters work in the body.4 These are found in aspirate, MSG and aspartame. In patients that removed all of these types of food additives from their diets, overall improvement in all symptoms was noted, showing a promise for a treatment option for urticaria that is not adding yet another medication to your regime.


1 Torresani, C., Bellafiore, S., & De Panfilis, G. (2009). Chronic Urticaria is Usually Associated with Fibromyalgia Syndrome. Acta Dermato-Venereologica , 389-392.

2 Chung, M. C., Symons, C., Gilliam, J., et al. (2010). The relationship between posttraumatic stress disorder, psychiatric comorbidity, and personality traits among patients with chronic idiopathic urticaria. Comprehensive Psychiatry , 55-63.

3 Weldon, D. R. (2006). Quality of life in patients with urticaria. Allergy and Asthma Proceedings , 96-99.

4 Smith, J., Terpening, C., Schmidt, S., et al. (2001). Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins. The Annals of Pharmacotherapy , 702-706.

This article was originally published on July 11, 2012 and last revision and update of it was 9/7/2015