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.