When you’re living with multiple sclerosis (MS), new symptoms like rashes or hives can be concerning. Several MyMSTeam members have experienced itchy, uncomfortable welts and questioned whether their MS might be the cause.

This article will tell you what you need to know if you’re asking questions like “Can hives be a symptom of MS?” or “Does MS cause rashes?” We’ll address what may cause hives and how you can manage them. As with any new symptom, talk to your doctor or neurologist (brain and nervous system doctor) if you think you’re experiencing hives. They can determine the cause and work with you to find a plan to help maintain your overall wellness and quality of life.

What Are Hives?

Urticaria (hives) are itchy, red bumps or welts (lumps) that may be uncomfortable or painful. These raised lumps under the skin can occur when the immune system releases histamine and immunoglobulin E antibodies in response to a perceived threat. Both histamine (a signaling chemical) and immunoglobulin E (a type of protein) are involved in allergic responses.

Allergic responses are intended to protect the body from foreign invaders that may cause illness. However, these defenses are raised when they are not needed, causing reactions such as hives.

Some people may develop hives due to a histamine intolerance, where the body has difficulty breaking down histamine properly. This can lead to various symptoms, including hives, even without a specific allergic trigger.

Can MS Cause Hives?

While MS itself doesn’t directly cause hives, having an autoimmune condition like MS may make you more susceptible to developing chronic hives. Several autoimmune diseases — including lupus, thyroid disease, and celiac disease — are known to cause hives. This connection is believed to be related to the overall immune system dysfunction that characterizes autoimmune conditions. It may also be associated with certain medications that are used to treat MS.

There’s no known direct connection between MS and hives. Unlike the characteristic symptoms of MS, hives aren’t a result of demyelination (damage to the coating of the nerves in the central nervous system, including in the spinal cord and brain). This doesn’t mean that the condition won’t cause hives, but it does mean that the connection isn’t common and that researchers don’t yet know how it works.

MS is sometimes associated with itching, which occurs due to nerve damage and doesn’t produce the itchy, discolored bumps associated with hives.

In addition, according to the World Allergy Organization Journal, women are more likely to develop hives and more likely to have MS. Researchers don’t yet know if this indicates a connection between the two conditions or if it is a coincidence.

Hives can show up in different ways. Usually, they disappear within 24 hours or after their cause is removed. However, in some cases, they can last longer if you have a condition called urticarial vasculitis, which can be painful. Some people with MS may also experience a specific type of urticarial vasculitis. Although this is uncommon, it’s important to talk to your healthcare provider, who may refer you to a dermatologist (skin specialist).

If you have MS and hives, ask your doctor or neurology team for medical advice. They may refer you to a dermatologist who can help treat and manage hives and the associated discomfort.

How Do People With Multiple Sclerosis Experience Hives?

Several MyMSTeam members deal with hives. One member asked others, “Quick question: Have any of you noticed a change in your skin since your diagnosis? I wouldn’t say a rash — more like hives?”

A few members have experienced hives as a side effect of the medications they took for MS. “I tried one medication and felt great on that until I had baseball-sized hives,” one member wrote. “Then, I tried another one and stopped that right away when hives started.” Another member shared, “I started with one drug but was only on it a couple months and broke out in huge hives. Then, I went on a second drug, which I started out in hives.”

Others have experienced hives as allergic reactions to over-the-counter medications, rather than as side effects from their MS treatments. “I can’t take ibuprofen or Aleve,” one shared. “They give me horrible hives that turn into welts and make my face swell so I look like an orangutan.”

What Does an MS Rash Look Like?

It’s important to note that MS-related skin changes typically don’t present as hives. When MS does affect the skin, it usually manifests as neuropathic pain. According to the Multiple Sclerosis Society, neuropathic pain can cause:

• Sensory symptoms like pruritus (itching) without visible rash
• Sensitivity to touch
• Burning sensations
• Numbness or tingling

What Can Cause Hives With MS?

Understanding why you randomly break out in hives can be challenging, but there are several reasons why people with MS may develop hives. Keep reading to learn more about the common causes of hives.

Medication Side Effects

Several medications used to treat MS can cause hives as a side effect. Although this may not happen with everyone, talk to your doctor right away if you develop hives after starting a new MS treatment.

The majority of these medications are disease-modifying therapies, which means they all change the immune system to fight MS. Sometimes, these modifications can trigger the release of histamine, which can lead to hives.

Medications that may cause hives or a skin rash include but are not limited to:

• Alemtuzumab (Lemtrada)
• Cladribine (Mavenclad)
• Glatiramer (Copaxone)
• Natalizumab (Tysabri)
• Ocrelizumab (Ocrevus)
• Ofatumumab (Kesimpta)
• Siponimod (Mayzent)

Allergic Reactions

Many people experience hives as an allergic reaction. This can be due to medication, as one of the above members reported. However, any allergic reaction can cause hives. People can develop hives as a response to:

• Foods, such as peanuts, tree nuts, shellfish, and milk
• Pollen
• Pet dander
• Latex
• Bugbites

Sometimes, you will be able to determine what caused your hives. Other times, the cause may remain a mystery. In these cases, it’s important to treat the hives and then see if they return. If they don’t, it might have been due to a one-time exposure to an allergen. If they do return, work with your healthcare provider to figure out how to proceed.

Certain Illnesses

Some people break out in hives when they have certain illnesses, like strep throat, COVID-19, or even a urinary tract infection. This may happen every time they get sick or only occasionally.

Responses to the Environment

You can develop hives when you’re too hot, too cold, too sweaty, or too stressed. Exposure to sunlight can also cause hives under certain circumstances. Some people wind up with hives when a belt, a strap, or another item of clothing is pressing into and irritating their skin.

How To Manage Hives

The key to treating hives is to find out what is triggering them and avoid these triggers. This process may take trial and error. Your doctor or dermatologist will review your medical history and can help you determine what particular substances or situations trigger your hives.

It may also be helpful to keep a journal of when hives occur and potential triggers to identify patterns. Try noting factors like:

• Foods you ate
• Medication you took
• Conditions in your environment (like hot or cold weather)
• Stresses
• Physical activities

If you suspect your MS medication is causing hives, talk to your neurologist. Your doctor may be able to treat your hives effectively so you can continue with the medication. Additionally, hives may be a short-lived response that goes away as your body adjusts to a new drug. If the hives don’t resolve, you and your doctor can discuss the risks and benefits of trying a different medication.

Your doctor may prescribe antihistamines, steroids, or immunosuppressants to treat the hives.

Antihistamines

Your doctor may prescribe or recommend over-the-counter antihistamines, like diphenhydramine (Benadryl). These medications reduce the histamines in your system, helping to alleviate the itching and discomfort associated with hives. Stronger antihistamines are also available with a prescription.

Steroids

Corticosteroids, also called steroids, are anti-inflammatory drugs that can help reduce inflammation and itching. Your doctor may recommend a topical steroid cream that you can rub on your hives or give you oral steroids, such as prednisone. However, it is important to only apply steroids for a short period of time. If you use them longer than your doctor recommends, it might damage your skin by causing thinning and easy bruising, and it may make you more vulnerable to infections.

Immunosuppressants

If you continue to have severe hives, your doctor may prescribe immunosuppressant drugs. Note that these may not be recommended for some people with MS, particularly those who are already taking medications that modify the immune system.

Home Remedies

You can soothe your hives at home by cooling the affected areas of your skin with a cool bath or shower or applying a cold compress. Wearing loose clothing — preferably made of 100 percent cotton, which is much gentler on your skin — and staying out of the sun may also help prevent the irritation that can cause or worsen hives.

Find Your Team

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 218,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Have you developed hives with MS? How did you manage them? Share your story in the comments below or by posting on your Activities page.