Lupus and Hives

posted in Skin Problems in Lupus on March 29, 2023 by

Gavin Abson

Updated February 8, 2025

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Systemic lupus erythematosus (SLE) can cause hives (also called urticaria). Hives are itchy, swollen bumps that appear on the skin. We usually think of hives in the setting of an allergic reaction. However, they can also occur due to autoimmunity. In addition, more than one type of hives can occur in SLE patients. In this article, we will discuss the connection between lupus and hives, the causes, and some recommendations to manage this condition.

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NOTE: Johns Hopkins University Press, publisher of The Lupus Encyclopedia, is a nonprofit publisher. If you purchase JHUP books, like The Lupus Encyclopedia, you support projects like Project MUSE.

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This blog on “Hives and Lupus” was edited and contributed to by Donald Thomas, MD; author of “The Lupus Encyclopedia.” Parts of this blog post come from “The Lupus Encyclopedia: A Comprehensive Guide for Patients and Health Care Providers, edition 2“

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Causes of Lupus and Hives

According to the Johns Hopkins Lupus Center hives affects 10% of SLE patients. 

The cause of hives in SLE patients is still unclear, but it seems to involve the immune system causing skin inflammation. 

Hives in SLE patients can also occur for reasons similar to those in the general population: allergic reactions. Drug, food, and environmental allergies (like pollen) can produce hives. These are treated with medications like anti-histamines. 

Recommendations

If you have lupus and hives, it is important to see your doctor. Here are some options for managing lupus and hives:

• Hives due to SLE usually improve when the immune system is calmed down with the usual lupus treatments. These include hydroxychloroquine, methotrexate, mycophenolate, azathioprine, belimumab (Benlysta), anifrolumab (Saphnelo), and steroids. Also, following the advice in The Lupus Secrets can help out a lot.
• Avoid triggers: If you notice that certain foods, medications, or other factors trigger your lupus-related hives, try to avoid them. Common triggers that can increase SLE disease activity (and lupus hives) include ultraviolet light, cigarette smoke, stress, lack of sleep, a poor diet, supplements that boost the immune system (like elderberry and Echinacea), and many more. Consider downloading the “Your Lupus Flare Plan” for guidance on preventing and managing flares triggered by certain factors.
• Hives due to allergies can be due to triggers like shellfish, nuts, drugs, pollen, and pet dander. Over the counter antihistamines (like diphenhydramine or loratadine) can help when they occur. Some triggers, like food and medications, can be avoided. However, they can make you drowsy. So, try using them when you are relaxing at home to see how you respond to them. 
• Take medications as prescribed. Studies show that only around one third of SLE patients take all their lupus medications regularly. Poor adherence is the primary reason for poor outcomes in lupus patients. Hydroxychloroquine is one of the most important drugs for controlling lupus and hives, so try not to miss any doses.
• I recommend PillPack to all my patients. Almost all US insurances cover its use. It makes it incredibly easy to remember to take medications without missing doses. It also saves a lot of time. You don’t have to spend an hour filling pill organizer boxes for the week or month. NOTE: I have no financial interest in PillPack. I use it myself. Prior to PillPack, it was easy for me to miss doses of my medications. 
• Cool compresses can reduce itching and swelling by reducing the skin inflammation from hives. Use a washcloth soaked in cold water, a frozen ice pack, or a bag of frozen vegetables, especially peas.
• Hot water can irritate hives. Try taking lukewarm to cool baths or showers instead.
• Tight clothing can aggravate hives, so opt for loose-fitting garments made from fabrics like cotton or silk.
• You can also find out more about treating dry skin in the post Dry Skin in Lupus.

For more in-depth information on hives and other lupus skin problems in greater detail:

Read chapter 5 and 8 of The Lupus Encyclopedia, edition 2

Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia.

If you enjoy the information from The Lupus Encyclopedia, please click the “SUPPORT” button at the top of the page to learn how you can help. 

What are your comments and opinions?

If you have had hives, urticaria, or angioedema from lupus, what has your experience been? What do you recommend for other patients?

Do you have any questions to ask Dr. Thomas?

Please click on “Leave a Comment” above to comment.

Please support “The Lupus Encyclopedia” blog post page

Click on “SUPPORT” at the top of the page to learn how you can support “The Lupus Encyclopedia“

Reviewed and edited by Donald Thomas, MD

For more in-depth information on Lupus and Hives:

Read more in The Lupus Encyclopedia, edition 2

Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia

If you enjoy the information from The Lupus Encyclopedia, please click the “SUPPORT” button at the top of the page to learn how you can help. 

What are your comments and opinions?

If you have lupus, what has your experience been? What do you recommend for other patients?

Do you have any questions to ask Dr. Thomas?

Please click on “Leave a Comment” above to comment.

Please support “The Lupus Encyclopedia” blog post page

Click on “SUPPORT” at the top of the page to learn how you can support “The Lupus Encyclopedia“