Hives are a common symptom experienced by women during pregnancy. Hives can occur throughout the entire pregnancy, with the third trimester being the most common time for these eruptions to occur. A clinical presentation of hives that are unique to pregnancy is called Polymorphic Eruption in Pregnancy (PEP, formerly known as PUPPP), which occur in 1 out of 600 pregnancies, during the third trimester.1 Hives are raised, red, itchy bumps that are formed due to the release of histamine by immune cells called mast cells. Histamine increases blood flow to the skin surface, recruit inflammatory cells to the skin, resulting in swelling, heat, redness and itching. PEPs present as large, cluster of hives which form plaques, and are often located on the abdomen, thighs and buttocks, typically within stretch marks developed during pregnancy.1 The activation of these mast cells can be due to common triggers in the environment such as dust, pollens, nickel in jewelry, medications, and chemical irritants found in products such as detergent. Temperature extremes, heat and cold, have both been found as triggers, with the former more common than the latter. Foods are a typical trigger for hives – reactions can range from immediate to delayed, with delayed reactions being more difficult to identify. Hives can also be triggered by emotional stress, a symptom that is common in pregnant women.
There are a few safe and effective ways in order to manage the symptoms of hives during pregnancy.
- Avoid temperature extremes: Makes sure your showers are lukewarm, neutral temperatures can help reduce increase blood flow to the skin triggered by hot temperatures. During hot, itchy phases, soaking in a cold bath can help reduce these symptoms.
- Oatmeal baths: Oatmeal is a very soothing herb that can reduce itching, swelling and provide some much needed moisture to the skin. Blend 1 cup of oatmeal in a blender (rolled oats are best) to create a “colloidal” substance, and add to the tub running with lukewarm water. Mix the oatmeal in with your hands, which should turn in to a smooth milky consistency. Soaking in a lukewarm bath with oatmeal for a minimum of 20 mins can help soothe the irritated skin.
- Moisturize your skin as dry skin may worsen the symptoms of itching caused by the stretching belly. All-natural shea butter, coconut oil and/or olive oil can provide moisture to the skin and are safe to use in pregnancy. Other topical treatments include aloe vera gel, calendula creams and witch hazel products that can provide a cooling, soothing effect.
- Vitamin C and flavonoids such as quercetin are antioxidants that are a safe and effective way to help manage hives from the source. These compounds have an anti-histamine effect which can provide stability to those hyperactive mast cells that are releasing the hive-producing histamine. Vitamin C also can helps the body rapidly break down histamine, reducing the time hives stay on the skin. Foods that are rich in vitamin C include dark, leafy, greens, bell peppers, strawberries, and citrus fruits. Foods rich in flavonoids are bright, colourful fruits and vegetables, as flavonoids are the compounds that give these foods their colour. Foods the richest in quercetin include apples, red onions and berries. On top of the anti-histamine effect, vitamin C and antioxidants regulate and balance the adrenal glands, which are organs responsible for the regulation of the stress response, therefore helping your body cope with stress more efficiency. You can take vitamin C orally in order to help with hives – maximum dosage for vitamin C in pregnancy is 2000mg daily. Anything higher than this dosage should be monitored by a physician knowledgeable in the field of nutrition.
- Food sensitivities can be immediate, or delayed. Immediate reactions are quite easy to identify and should be avoided. Delayed hypersensitivity reactions are often caused by overexposure to foods to which the immune system eventually develop an intolerance, which makes the triggering food difficult to identify. There are tests you can have done by your medical or naturopathic physician in order to identify foods that may be increasing the inflammatory state of the body. By reducing exposure to these foods, the immune system can stabilize and become less reactive to environmental and other triggers that may also be causing the hives
Hives are caused by a number of different triggers and can occur throughout the pregnancy. The severity of hives ranges from mild to severe. Before trying over the counter anti-histamine medications, try these safe and effective tools you have at your fingertips in order to identify and solve the problem from the source. There are a number of herbal and homeopathic remedies that can be prescribed by naturopathic doctors if you need extra support.
Dr. Tanya Lee, N.D. received her Honours Bachelor of Science degree in Biochemistry and Biomedical Sciences from McMaster University and was trained as a Naturopathic Doctor at the Canadian College of Naturopathic Medicine. Dr Lee practices full-time between two clinics located in Toronto and Milton Ontario and has been voted Milton’s favourite Naturopath in 2013 and 2014. Her primary care practice focuses on family medicine, treating a wide variety of conditions such as hormonal (endocrine) disorders, fertility, digestive problems, cardiovascular disease, diabetes, insomnia and fatigue. She has a special interest in the treatment of autoimmune diseases, paediatric and perinatal health. Tanya offers her clinical knowledge to a number of publications, including the NaturalPath.
- Bergman H al Pruritus in pregnancy: treatment of dermatoses unique to pregnancy. Can Fam Physician. 2013 Dec;59(12):1290-4.
- Patak P et. al Vitamin C is an important cofactor for both adrenal cortex and adrenal medulla. Endocr Res. 2004 Nov;30(4):871-5.