4) Food cofactors & additives (beyond classic allergies)
True IgE-mediated food allergy can cause hives—but so can food + exercise together (food-dependent, exercise-induced anaphylaxis), with wheat a frequent culprit. Alcohol and NSAIDs can amplify these reactions.
Some people with chronic hives report flares with “pseudoallergens”—certain food additives (e.g., benzoates, tartrazine) or sulfites—though the scientific evidence is mixed and generally limited. A short-term, supervised trial of an additive-reduced diet may help selected patients.
5) Autoimmune & hormonal links (the inside job)
Chronic spontaneous urticaria is often autoimmune-driven. A well-documented association
