DEAR DR. GOTT: I have these spots that keep breaking out. The doctor told me it was urticaria. Can you tell me something about it, how I can get rid of it and what causes it to keep coming and going away? When the spots come, they burn from the inside out and they break and turn red on the outside of my skin.

The doctor gave me pills to take but they didn’t help. This has been going on for the last 2 ½ years. At first I though it was caused by nerves but I haven’t had any problems recently.

DEAR READER: Urticaria, otherwise known as hives, is itchy, red (or sometimes white), raised welts that appear on the surface of the skin. They can change shape and disappear, only to reappear again and again. They may enlarge, spread and join together to cover a greater area of the body, lasting less than an hour or as long as a few weeks.

Hives can be triggered by such things as exposure to specific medications, food or food additives, insects, animal dander, infection or parasites. In some instances (although rarely), stress and autoimmune disorders that may be linked to other health problems such as a thyroid abnormality or lupus, may be the culprit. Testing by an allergy specialist may be extremely helpful in ruling out some of the more common possibilities believed to be the cause. Whatever the trigger, hives develop when an allergic reaction occurs and the body releases histamine and other chemicals into the bloodstream, resulting in itching, redness, irritation and the complaints you experience. Symptoms may not always be present with each outbreak.

Diagnosis is generally made through visual examination by a physician. When any question remains, a skin biopsy can be performed for clarification.

Treatment for the disorder depends on the severity of the condition. If your complaints are generally mild, nothing may need to be done. A first step for mild-to-moderate cases might be to take an over-the-counter antihistamine such as Benadryl or chlortrimeton that might cause drowsiness but should be effective. Keep in mind that an antihistamine will lessen or stop your symptoms for a time but will not treat the underlying cause of the rash. To complicate things, antihistamines are now divided into two categories, sedating and non-sedating, each available with over-the-counter options and others that require a prescription. Newer antihistamines such as Claritin, Zyrtec, Allegra and others are non-sedating and might be better tolerated for daytime use. This option might be followed by oral corticosteroids such as prednisone that should only be used short-term. Complications from extreme reactions, to include anaphylaxis that causes breathing difficulties, should be treated as an emergency with epinephrine or steroids.

On the home front, I might suggest you begin by keeping a log of your daily activities and diet, soaps and lotions used, encounters with animals, or specific substances if you experience an outbreak. It will also be beneficial to keep track of times to better determine if there is a link between a certain product or food and your hives. For example, did you take a new medication, eat a specific food, hold a cat on your lap, add an over-the-counter supplement or herb to your morning diet, or have a recent infection? Any correlation over a period of time might shed light on the cause for your outbreaks. Try avoiding the offending substance(s) and perhaps you will solve the problem. Then, avoid stressful situations whenever possible. Don’t wear tight-fitting clothing and avoid hot showers and baths. Remain out of direct sunlight and avoid temperature extremes.

Remember that hives are not harmful, simply uncomfortable, itchy, may burn and are downright frustrating. Play the detective game and help your physician or allergist help you solve the puzzle.

Readers who would like related information can order my Health Report “Allergies” by sending a self-addressed. Stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.

DEAR DR. GOTT: The woman you wrote about who is getting hives and knows that they were previously caused by aspirin might now be taking ibuprofen (Advil, Motrin, Midol) which is causing the allergic reaction.

I had a similar problem 30 years ago (and for some strange reason it seemed to mostly happen during the night just like this woman). I went to an allergist and was told that these two drugs are cross-reactive, meaning they have very similar actions and side effects even though they have different chemical compositions. Now I am left with only being able to take acetaminophen (Tylenol) which is not nearly as effective and which has dangerous side effects such as liver toxicity that can result in death! Needless to say, I usually just suffer with the aches and pains and look for natural remedies and exercise.

DEAR READER: Thank you for sharing your experience. I have printed it in the hopes that it may also help others. Generally speaking, it depends on the type of reaction whether one should stay away from aspirin or all non-steroidal anti-inflammatory drugs (NSAIDs).

In my experience, many people who cannot take aspirin do well with ibuprofen and other similar medications. However, with the recent issues with so many over-the-counter pain relievers, many people have chosen to stop using them and instead try home remedies and alternative medicines.

Pain relief options depend on the cause but can include physical or occupational therapy, castor oil rubs, purple grape juice with liquid pectin, apple pectin capsules, over-the-counter Castiva, water aerobics, massage, acupressure, acupuncture, and much, much more. Most are safe and inexpensive but I always urge interested individuals to discuss any home or alternative remedies with their physicians, as some may not be safe in conjunction with certain medical conditions or medication.

Readers who are interested in learning more can order my Health Reports “Compelling Home Remedies” and “More Compelling Home Remedies” by sending a self-addressed, stamped number 10 envelope and a $2 (for each report) US check or money order to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print an order form from my website, www.AskDrGottMD.com.

DEAR DR. GOTT: What causes hives and itching on eyelids? When I first got them 30 years ago I found out the culprit was aspirin. I don’t take it any more but lately I’ve been getting them again, especially at night. I’m a 76-year old female.

DEAR READER: Chronic idiopathic urticaria (hives) result in extremely itchy, red welts that form on the skin, particularly that of the lips and eyelids. This rather common phenomenon affects almost 20% of the population at some stage during a lifetime. It may be from an allergic reaction to food, an insect bite, medication, stress, heat, cold, chemicals, exercise, and a number of different causes.

Because the exact cause of hives can be extremely difficult to determine, you might consider keeping a journal for up to a month prior to each outbreak. It is important to know what medications have been taken — to include over-the-counter products, whether you exercised, changed laundry detergents, used a new bathroom cleaner, pet a neighbor’s dog, found yourself under additional stress, ate foods with MSG or peanut oil, or whether you spent time out of doors in the fall when many people become stuffy and breathing becomes difficult. Remember that no journal notation can be taken too lightly because if the same symptom or symptoms precede several outbreaks you may have your answer. As odd as it may sound, perhaps you fail to wash your broccoli before cooking it. If it happens to be treated with pesticides or other chemicals prior to shipment, the solution will be simple. If your problem occurs primarily in the evening, can you link it with a room freshener or oil or to a pet that sleeps in the same room with you? Could a cat be curling up next to your pillow?

Simultaneously, you might try using Benadryl or a non-sedating antihistamine such as Claritin, Zyrtec or Allegra. More potent antihistamines, hydroxyzine and doxepin can be used, however they could cause drowsiness and unwanted side effects. In extreme cases, corticosteroids in extremely low doses may be prescribed by your physician. Avoid using makeup, mascara or eye liner for a time. Be sure your shampoo doesn’t run over your face when you shower. Don’t rub your eyes if your hands have been exposed to any lotions, soaps or chemicals, since this unconscious rubbing could cause the irritation.

Thirty years is a long time to have an on-going problem. You don’t indicate whether you have seen an allergist who can perform testing on common irritants. This might be an appropriate next step for you to take.

Readers who would like related information can order my Health Reports “Allergies” and “Dermatitis, Psoriasis and Eczema” by sending a self-addressed stamped envelope and $2 US for each report ordered to Peter H. Gott, PO Box 433, Lakeville, CT 06039-0433. Be sure to mention the title(s) when writing or print out an order form from my website www.AskDrGottMD.com.

DEAR DR. GOTT: I enjoy your column very much. I went to a physician for hives. He did a host of blood work and only found low vitamin D levels. He said there is an ingredient called carrageenan that causes allergic reactions and inflammation in the body. He told me to go home and check everything I use to see if it’s in there. Sure enough, the creamer that I have every day had it in there. I thought that this couldn’t possibly be the answer; it was too simple. I stopped using the creamer anyway, and my hives disappeared. Just to be sure, I used the creamer again and broke out with hives within 30 minutes.

The amazing doctor who suggested this to me during my one visit then “ran off” to Arizona to practice integrative medicine. I only knew him as Dr. P, but I will always be grateful to him. Please share this with your readers so that maybe it can help some of them, too.

DEAR READER: Carrageenan is a seaweed extract used in processed foods. It is used as an emulsifier (prevents liquids from separating); helps stabilize crystals, such as ice and sugar; and changes the texture of foods (thickens or makes them chewier).

According to the National Institutes of Health (NIH), it is known to cause anaphylaxis in sensitive individuals during barium enema (of which carrageenan is a component). It is also thought that it could account for some of the problems babies experience using milk products or certain baby formulas.

To the best of my knowledge, an allergy to carrageenan is treated as a food allergy, meaning avoidance of the product is the best option. This involves thorough label reading and diligence.

DEAR DR. GOTT: I read your article about hives. The writer said her problem began after having bilateral knee replacements. I’m just wondering if the hives could be caused by an allergic reaction to any of the materials used in her knee replacements. Before my knee replacement, I was asked if I had any known allergies to metals, nickel in particular. I wish the writer the best and hope she has found the source of the problem.

DEAR READER: I am sure that the writer was also asked about any known allergies; however, perhaps the problem lies in something that she did not know. Nickel allergy is most commonly associated with jewelry, particularly inexpensive gold-plated pieces. If the reader doesn’t wear any or wears only high-quality jewelry, she may not have known. Allergies can also develop suddenly to substances that were previously handled without a problem.

I am printing your letter because you bring up an excellent point in that the hives may be directly caused by the knee replacement and a resulting allergy. Thank you for writing.

Readers who are interested in learning more about allergies can order my Health Report “Allergies” by sending a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website’s direct link at www.AskDrGottMD.com/order_form.pdf.

DEAR DR. GOTT: I am writing in regards to your column about the woman with activity-induced hives. I, too, had a problem similar to that of the reader.

I had gone to have a facial and bought some of the products they offered. About a week or 10 days later, I started getting hives. They would appear out of nowhere. If I bumped my arm, a few minutes later I would have hives in that area.

As it progressed, my feet and hands would swell up. My lips would swell even with pressure. Sometimes the hives would appear like a thousand mosquito bites, and within 10 minutes would disappear. Some days all I could do was sit on the couch because I didn’t want to cause the hives to appear.

This went on for months. I went to my regular doctor and saw an allergist. The specialist could find nothing that I was allergic to that would cause hives like I was experiencing. I was on Allegra for more than a year. During all this, I gave my daughter the cleanser I had gotten after the facial.

After about a year, I quit taking the Allegra and didn’t have any hives. I was OK for a while. I started using the cleanser again, and the hives came back! Years earlier, when I was pregnant, I read about sorbitol and learned of some of the problems it can cause. I had been taking an antacid for heartburn when I was pregnant and had had an unexplained case of diarrhea that went on for several weeks. Fast-forward to the facial cleanser: It contained sorbitol.

Since then, I have found that several members of my family cannot tolerate anything with sorbitol in it. Sugar-free gums (sweetened with sorbitol) give my youngest child diarrhea within 30 minutes. My younger sister has hives like I do when she uses products such as shampoo, soaps and beauty products that contain sorbitol. My aunt gets hives after eating sugar-free candy. So, when I read this letter to you, and saw that the woman had been on Weight Watchers. I thought she was likely using diet products with no sugar that were sweetened with artificial sweeteners, such as sorbitol.

It is also used in some immunizations, such as Gardasil.

DEAR READER: Sorbitol is a known laxative. In fact, it has been added to certain medications specifically for that reason. Actidose with sorbitol is one of those medications; it is used to bind poisons and other toxic substances in the body, and then aid removal by inducing a bowel movement. Sorbitol is also available by prescription as a urologic irrigation solution used to remove debris and prevent infection following bladder and other urinary-tract surgeries.

Side effects include allergic reaction (hives, rash, difficulty breathing, itching, etc.), chest pain, vomiting, confusion, diarrhea, seizures, changes in heart rate and more.

Sorbitol, as you already know, is also used as an artificial sweetener in many sugar-free products and as thickener and humectant (aids moisture retention) in cosmetics and many other products. It can also be produced within the body and can cause eye and nerve damage in diabetics.

So while there is no escaping all sources of sorbitol, people sensitive to it should read labels and reduce exposure.

Readers who are interested in learning more about allergies can order my Health Report “Allergies” by sending a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website link at www.AskDrGottMD.com/order_form.pdf.

DEAR DR. GOTT: I am begging for help, please. I am 73 years old and have lost 120 pounds on Weight Watchers. My problem is that when I walk, take a bath, get excited, angry or upset, I break out in hives that look like measles. And they’re so itchy!

I have been to a few doctors, and they tell me to take antihistamine tablets, but I cannot tolerate them. I need to walk to keep my weight down and my “new” knees working. This started four years ago after having bilateral knee replacement, but I’m not sure if there is any connection. I walked three miles a day before but cannot do that any longer. I know you are busy but hope you will reply. I am willing to try anything.

DEAR READER: Hives are red or white, raised, itchy welts that appear on the skin. They can be either acute or chronic. Acute hives can last from several minutes to up to six weeks. Chronic hives last longer — perhaps for more than six months. As a general rule, hives are harmless and don’t leave any lasting marks, even when left untreated.

A condition known as angioedema resembles hives but is more serious. It occurs deeper in the skin and can present with swelling, blisters, pain, abdominal cramping, severe swelling of the face, arms, hands, legs, feet and genitalia and, in severe cases, difficulty swallowing and/or breathing.

Both conditions are triggered when mast cells release histamine and other chemicals into the bloodstream and skin. Causes might include exposure to latex, pollen, animal dander, insect stings, shellfish, nuts, most medications, heat, cold, sunlight, emotional stress, exercise and a host of other possibilities. Hives and angioedema can occur in response to the body’s production of antibodies because of immune-system disorders such as cancer, lupus, some thyroid disorders, hepatitis and other infections, and the common cold. Hereditary angioedema is linked with low levels or the abnormal functioning of specific blood proteins that play a rule in regulating how the immune system functions.

If symptoms of either condition occur regularly and your physician cannot determine the cause, try a patch test, where an allergen is applied to the patch that is placed on the skin. Latex and medication reactions might be discovered. An intradermal test uses purified allergen extracts that are injected into the skin of the arm and will likely determine whether a person is allergic to one or more substances, such as penicillin or insect venom. Testing that punctures, scratches or pricks the skin should identify food, pollen, animal dander and reactions to other substances.

Treatment includes over-the-counter diphenhydramine, loratadine, cetirizine and chlorpheniramine; the application of cool, wet compresses; bathing with tepid water sprinkled with baking soda and/or uncooked or colloidal oatmeal; and prescription levocetirizine, hydroxyzine and desloratadine. Severe cases might require the use of an oral corticosteroid.

It appears your hives might be triggered primarily by physical and emotional stress. Consider yoga or tai chi instead of walking. Experiment with different water temperatures and soaps when bathing. Try to reduce your exposure to emotionally charged situations, and practice relaxation techniques such as meditation or deep breathing. When something triggers the hives, make a mental note (or keep a journal) and avoid it in the future. In other words, take whatever steps are necessary to reduce your stress level.

DEAR DR. GOTT: Last fall, I developed sporadic itching that turned into hives. After that, I felt ill with a sore throat, general weakness and fatigue after very little exercise. I read about a ragweed allergy and its relationship to certain foods. I eliminated them and feel better. Could these hives be related to allergies and food combinations? Is the sore throat and lethargy related to an allergy?

DEAR READER: Maybe. Ragweed allergy, commonly known as hay fever, presents with itchy eyes, scratchy throat, runny nose and fatigue but not generally hives. Food triggers include sunflower seeds, chamomile, cantaloupe, bananas and some honeys. The most common treatments for hay fever include remaining indoors when the pollen count is high, taking antihistamines and allergy shots. My guess, however, is that you have a true allergy, which is best treated with total avoidance once the offending substance is identified. Good luck.

DEAR DR. GOTT:
My husband has a perplexing problem with hives. He is 59-years-old. He is currently taking Benicar, Toprol, simvastatin and a low-dose aspirin every day for cholesterol and blood pressure problems but is in good overall health. I don’t believe these play a role in his current affliction, however, because the hives started several years before he was prescribed these medications.

He first began getting the hives while working but now that he is retired, they still occur. He has seen his primary care physician and an allergist, both of whom have not been able to offer any suggestions. After hearing a detailed description of an “attack”, they both said they didn’t believe it was due to food or drug allergies.

He has seen his physician a few times during an attack but all they do is give him some sort of injection and a prescription for prednisone which he doesn’t like to take. He usually has three to four attacks a year but they can occur at anytime. For instance, his last attack was in January and the one before that was in August while we were on vacation in a completely different environment.

His symptoms and the frequency of the attacks seem to be worsening. I have finally decided to write because he is having yet another attack and I feel so helpless. I just want him to be able to have a more normal life. I will describe the January attack (as it is a pretty typical one) in the hopes it will help you help us.

Jan. 2 – woke up at 7 am with his left hand pink and swollen. Throughout the day the swelling and pinkness spread up his arm. He was very tired. That night he developed chills and a fever.

Jan. 3 – woke up at 5 am with sinus drainage and minor coughing. Both hands had become swollen and he had body aches. His top lip was also swollen (never affects throat or breathing) and he had large pink welts over most of his body. His fever had gone down but not away and he was still very tired. By mid-afternoon his bottom lip had become swollen. He slept most of the day due to a combination of fatigue and Benadryl (to try to alleviate the swelling).

Jan. 4 – lips were almost back to normal but he was still tired and achy. He still had the very large pink hives and felt chilly.

Jan. 5 – feeling better but still had large pink blotches.

Jan. 6 – blotches were starting to flatten.

Jan. 7 – hives almost gone.

DEAR READER:
Your husband appears to be having several attacks of acute urticaria (hives) a year. Acute in this instance means that the hives last for less than six weeks.

According to both the American Academy of Dermatology and the American College of Allergy, Asthma and Immunology, there are three common causes of urticaria. These are allergies to foods (such as shellfish, peanuts, dairy or others) and reactions to medications such as penicillin and infections. Insect bites, internal diseases, cold, or sunlight are other, less common causes.

I believe the cause of your husband’s hives is infection. Thanks to your detailed description, it appears that there are two things going on. First, he experienced swelling and redness in a small area that progressed throughout the day. He then developed upper respiratory infection symptoms (which can take 12-36 hours to appear following exposure) followed by worsening hives.

I don’t think there is any coincidence in the fact that his symptoms last approximately seven days, which is the average length of the common cold. Since I am not an allergist, I cannot give specific information about how to treat these hives. I also do not know if there is a way to prevent symptoms from appearing since each infection is likely to be due to a different strain of bacteria or virus.

If your husband improves while using prednisone, I urge him to speak with his physician about using it. Small doses for short periods of time will not cause side effects and long-term damage is avoided. The prednisone probably won’t help the cold but it will be a lot easier to deal with a simple cold by itself without having itchy, swollen blotches all over his body as well.

Bring my response to his allergist and ask his opinion. He or she should also be able to provide possible treatment options at that time.

To give you related information, I am sending you a copy of my newly written Health Report “Allergies”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR DR. GOTT:
Thank you so much for you column. My mother and I live 1200 miles apart and both read it daily in our newspapers. We have learned so much from you — especially the bar of soap trick, what a lifesaver!

I’d like to ask your thoughts about recurrent, chronic hives. I’ve suffered from this problem for several months. I itch, I scratch, and then I get welts. They generally disappear in a half hour or so but pop up again somewhere else. It happens two-eight times a day, every day. Antihistamines help but do not totally get rid of the symptoms. I recently took a six-week trip from Florida to Nova Scotia, thinking all during the trip that the complete change of food and atmosphere would help the hives if they were from an allergic response. They kept on coming, daily, during the trip, just as they do at home.

My allergist has tested for me foods, chemicals and inhalants. I am allergic to some trees and grasses but when I have the hives I do not have respiratory symptoms. My dermatologist drew an X on my back with his fingernail, but no hives resulted. The welts do not appear if there’s no itch first. A blood test only revealed that I have a rather high eosinophil count (19% in the last test).

I’ve spent hundreds of dollars on tests and doctors, with no conclusive results. Based on reading I’ve done, I think this is idiopathic and I may just have to learn to live with it but I don’t recall ever seeing chronic hives discussed in your column. Any thoughts or ideas you have would be helpful, not only to me but to many others as well.

DEAR READER:
Chronic, recurring hives can be very difficult to treat. The problem is often compounded by the fact that almost half of all cases are idiopathic, meaning they have no known cause.

Your elevated eosinophil count is telling. These specialized white blood cells are usually only active during certain allergic diseases, infections (primarily parasitic), and in the presence of certain medications. Allergic disease can include asthma, eczema, hay fever, and autoimmune disorders. Medications include amphetamines, certain psyllium laxatives, certain antibiotics, interferon and tranquilizers.

Most chronic hives occur daily (as yours do) but last for several hours. Hives also tend to itch only after developing. Because yours do not appear until after itching and scratching, your dermatologist correctly performed a pressure test. This test using a blunt point and in individuals with delayed pressure urticaria (hives), the area drawn on will develop welts. This may occur within minutes but may take several hours before they are obvious. Again, however, you are atypical with welts only appears after scratching. I am tempted to say that you have a strange combination of delayed pressure urticaria and eczema (an area of dry skin that itches then rashes after scratching); however, I am not a dermatologist.

I urge you to seek out second opinions from a dermatologist and allergist. They may be able to provide new insight and order new testing. Because your symptoms are chronic, recurring and clearly affecting your quality of life, I recommend you visit the dermatology and/or allergy clinics of a teaching hospital. I note that you live in Florida. You are in luck because there is a specialty resource known as The Mayo Clinic located in Jacksonville, FL. You may also wish to check out some of the universities near you to see if any offer clinics at area hospitals where medical students and professors see the general public. This is a great option because you will be getting excellent care and aiding in a student’s education.

In the meantime, I recommend you take antihistamines as a preventive to reduce your symptoms.

To give you related information, I am sending you a copy of my Health Report “Allergies”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.