Help for Hives – Continued

With An Emphasis on Non-Drug Strategies

David J. DeRose, MD, MPH
As presented on the Three Angels Broadcasting Network’s Health for a Lifetime
Taped December 2005


(2) Elimination Diet. A diet that avoids many common—as well as unusual—triggers has been advocated by some experts. Others argue that such diets are not only impractical, but without carefully reading ingredients, contacting food production companies (e.g., to find the source of things such as “natural flavorings;” or to ensure that no traces of forbidden foods may have contaminated food production machinery), etc. no such diet could be efficacious. Despite such concerns, I have seen patients with a variety of conditions improve following elimination diets.


Basic elimination diet strategy. If the problem is not severe and occurs only occasionally, e.g., a few times a month, avoiding only the foods in the Level One column may be the best strategy. This excludes many of the compounds alleged to be the most common offenders, yet is easier to tolerate than the Level Two diet. The Level Two diet may be a better choice if severe and/or daily (or near daily) symptoms are present.

Once symptoms resolve, we often begin adding foods (one new food every other day) starting with asterisked foods in the Level Two column. When all these foods have been added, we typically progress by adding other foods in the Level Two column. Subsequently, the same process is followed with the Level One column. (If a person employed only the Level One diet initially, he/she will first add foods with an asterisk in that column, then progress to other foods excluded during the elimination phase.) If hives recur at any point in the process of adding formerly excluded foods, eliminate the last two foods added and see if the hives resolve. If they do, do not try to reintroduce those two foods for at least three months; even then, only use small quantities—no more than once per week. If any food provokes severe allergic symptoms (such as breathing difficulties, or lip or facial swelling), do not try to reintroduce the food. Such severe allergic manifestations can be life threatening; reintroduction of such foods is usually not warranted—even if it is done under a doctor’s direct supervision.


Elimination Diet Food Chart 

Category Level One Level Two(Avoid Everything in Level One Plus Everything in this Column) Items Always Permissible
  • Wheat and other gluten containing grains:

o Barely*

o Rye

o Oats*

  • Corn
  • Rice*
Nuts, Seeds, and Legumes
  • All nuts (including peanuts)
  • Soy
  • Specific seeds
o Sesame seeds
o Poppy seedsAll other legumes*
Seeds not listed at left
Dairy and Eggs
  • Milk and other dairy products
  • Eggs
N/A None
Other animal products
  • Fish
  • Chicken
  • Red Meat and all other flesh foods (tend to favor inflammation)
  • Berries
  • Citrus
  • Bananas*
  • Kiwi
  • Fruits with high likelihood of pesticide residues
o Grapes*

  • Fruits that can cross react with ragweed pollen sensitivity:

o Watermelon

o Cantaloupe

o Honeydew

  • Fruits that can cross react with birch pollen sensitivity:

o Apple

o Cherries

  • Apples
  • Pears
  • Stone fruits

o peaches

o plums

o nectarines

Vegetables N/A
  • Vegetables that can cross react with birch pollen sensitivity:

o Carrot*

  • Nightshades:

o Tomatoes

o Potatoes

o Egg plant

o peppers

Vegetables not listed at left

* = foods to be added before others in the same column if the elimination diet is effective




Category Level One Level Two(Avoid Everything in Level One Plus Everything in this Column) Items Always Permissible
Water N/A Everything but distilled water (coupled with charcoal pre-filtration) Distilled water
  • Chocolate
  • Yeast

o Nutritional yeast

o leavening yeast*

  • Alcoholic beverages
  • Selected flavorings, preservatives and colorings:

o Tartrazine (yellow dye)

o Sodium metabisulfite

o monosodium glutamate

o nitrites

o cinnamon


  • All herbs, vitamins other and supplements
  • All other artificial flavorings, preservatives, and colorings
  • Added salt (alternately can limit salt to 1000 mg per day)
  • Caffeine
  • Hot spices




* = foods to be added before others in the same column if the elimination diet is effective


Note: Although the Level Two diet excludes all herbs and supplements, some choose to use anti-inflammatory plant products in conjunction with either Level One or Level Two Elimination Diets. These include:

(1) Using plant oil supplements and other oil rich agents:

Flaxseed oil one to two tablespoons (or three capsules) three times daily with meals

Gamma linolenic acid (GLA) 2 capsules three times daily to deliver approximately 1500 mg daily (may come from black currant, borage, or evening primrose)

(2) Using anti-inflammatory herbs:
Turmeric: 500 mg three times per day
Ginger : 250 – 500 mg two to three times daily


(3) Using other supplements:
Vitamin E: 400 IU twice daily



Selected References
“Chronic Urticaria and Physical Urticarias” in Habif: Clinical Dermatology, 4th ed., Mosby, Inc. 2004
“Urticaria and Angioedema (Hives),” Chapter 136, in Behrman: Nelson Textbook of Pediatrics, 17th ed., Elsevier 2004
“Miscellaneous Inflammatory Diseases of the Skin and Cutaneous Drug Reactions,” Chapter 95, in Noble: Textbook of Primary Care Medicine, 3rd ed., 2001 Mosby, Inc. 2001.
Federman DG, et al. The effect of antibiotic therapy for patients infected with Helicobacter pylori who have chronic urticaria. J Am Acad Dermatol. 2003 Nov;49(5):861-4.
Kozel MM, et al. Laboratory tests and identified diagnoses in patients with physical and chronic urticaria and angioedema: A systematic review. J Am Acad Dermatol. 2003 Mar;48(3):409-16.