Breaking Out in Hives?

Hives- the very thought of these itchy, raised, red splotches make me start to squirm and scratch. With our oak allergy season in full bloom here in Austin, we see the full spectrum of allergic complaints- from sneezing, sore throats, dry coughs and itchy eyes to skin reactions such as hives. The medical term for hives is "urticaria". These lesions come and go, and often cause a burning sensation along with the itch.

In the previous blog entry about allergic eye problems, I mentioned that histamine (the substance that causes the redness and itch of allergic reactions) is stored in cellular level containers called mast cells. With urticaria, the basic problem is that these mast cells degranulate, releasing their highly inflammatory contents. The good news is that typical lesions resolve within 24-48 hours, but the bad news is that they can quickly reoccur and become a chronic problem.

But Doctor, what caused my hives? Was it the shrimp I ate yesterday?
Unfortunately, identifying the triggering cause for hives can be extremely challenging, because there are so many different potential culprits. Infections (especially from Strep and mononucleosis), drugs, foods, pollens, chemicals, metabolic disorders (like thyroid) and even rarely underlying cancers can all be to blame. Additionally, urticaria can be triggered physically, from cold or heat, pressure, or sunlight.

Treatment focuses on antihistamines initially, and often this is all you will need- especially if this is the first time you have ever had hives. Non-sedating antihistamines are used for daytime, and our old standby diphenhydramine (Benadryl) works well at night for those who need help sleeping. If these medications are not enough, clinicians have stronger medications such as steroids or other histamine receptor blockers that may be added.

What can you do as well? Avoid extreme or sudden changes in temperature, including hot showers. Avoid alcohol and NSAIDS (ibuprofen, naproxen), both of which can aggravate hives. Stay out of the sun. Applying topical calamine lotion provides relief to some people. If you develop a chronic problem, consider keeping a diary to help identify potential triggers. Happily, approximately 70% of people with first time hives will have resolution of their symptoms within three days, regardless of which treatment they use.

BOTTOM LINE: If you break out in hives, start with OTC antihistamines and be assured that it is okay to give yourself a couple days before you head to your doctor, as long as your itching is tolerable. 

Seeing Red This Spring?

What should you do if your primary allergy symptom is not sneezing, runny nose, or sore throat, but burning, itching, watery, red eyes? Will over-the-counter products help with eye symptoms?
The short answer is yes- oral antihistamines (like Benadryl, Allegra, Claritin & Zyrtec) can help with allergic eye symptoms, but if you are really only having eye issues, you may get better relief from some prescription eye drops.

Many of my patients try to use over-the-counter eye drops that "get the red out"...only to discover that they need more and more of these drops to accomplish the same results. The only time that I recommend these OTC products (which have vasoconstrictors to eliminate red eyes) is for extremely short-term use, such as if you are giving a presentation or taking pictures. If you use these products for more than a couple days, you will develop rebound symptoms of increased redness, and risk getting pulled into the vicious cycle of red eyes, use drops, worse red eyes when drops "wear off", more drops, etc.

Prevention is key for allergies in general, and especially helpful with eye symptoms. While avoidance of the allergen is your first choice, often that is not possible or practical. There are a variety of both over the counter and prescription eye drops that can greatly reduce eye irritation and discomfort from allergies. Some are antihistamines, but others are more pro-active prevention. Histamine (the substance that triggers the redness and itch) is stored in "holding tanks" called mast cells. Mast cell "stabilizing" drops were designed to keep the histamine staying in the holding tanks, rather than being released to cause havoc.  There are also prescription combination antihistamine and mast cell stabilizing drops, which can be applied only once or twice daily. Finally, there is another class of medication that is purely anti-inflammatory.

What "home" remedy helps? For quick relief of itchy eyes, try wrapping a dampened washcloth around  some ice cubes, and hold this cold compress up to your eyes for a few minutes. Heat is NOT the answer for this eye problem! Heat releases histamine, and simply ramps up the problem.


BOTTOM LINE: If your eyes are driving you crazy during allergy season, don't suffer in silence, but schedule a visit with your family doctor or eye doctor to find out your treatment options!

Itchy Eyes, Runny Nose...Achoo!

No April Fool's...here in Austin, Texas, we are fully into OAK ALLERGY season. Our cars have a dusting of yellow pollen, and the streets are strewn with oak droppings. Is it time for a trip to your family doctor or allergist? Maybe, but there are several remedies you can try on your own first.

What are signs and symptoms of allergies?

At the risk of sounding like an antihistamine commercial, it's sneezing (often in fits of sneezes), itchy eyes, itchy throat, scratchy throat, drainage down the back of your throat (which creates early morning sore throats that often fade mid-morning), stuffy eyes, ear pressure and the lovely dark circles under your eyes.

What is recommended for treatment?

Typically we start with the non-sedating antihistamines,which used to be prescription but are now available over the counter (OTC). These include Loratadine (Claritin), Fexofenadine (Allegra), and Cetirizine(Zyrtec), to name a few of the most popular. Which is BEST? In my experience, they are equally effective overall. However, what works for you this year may not work as well next year, and there is not great science to explain why. Antihistamines will DRY you up and STOP ITCH. If you are mainly stuffy, you are better off with just a decongestant such as phenylephrine (Sudafed) or if you have both, grab a combination product.

If you are suffering regularly in a particular season, or perhaps year-round from something like molds, your doctor may recommend more preventative therapy such as nasal steroid sprays. These sprays are prescription, and they are not "addictive" like the OTC ones. The OTC sprays that give immediate relief are fine for a day or two, but beyond that, you will get rebound nasal congestion and be chasing your tail with symptoms/spray/more symptoms/more spray. Nasal steroids are minimally absorbed (so no turning into Arnold, gaining weight, or weakening your bones.) They are very safe, and decrease swelling while creating kind of protective barrier against entering irritants, so you don't turn on the histamine system that causes allergy symptoms.

What more prevention can you do?

Well, it's April 1st, so like every first of the month, I recommend changing out your home's air filters! Even the "central" or "media filter" type should be changed at least three or four times per year, despite manufacturer recommendations of annual replacement. Yes, that is expensive, but cheaper than many allergy medications, and no other side effects! Consider posting a reminder on your calendar to change your filters every few months. HEPA air cleans and vacuum bags are of unclear efficacy, but may help. Limit your outside exposure (get on the exercise bike or treadmill indoors.) If you really suffer, consider getting rid of carpet and drapes in your home, and restricting pets to outside the bedroom.

BOTTOM LINE: If you can't stop sneezing or are having other signs of seasonal allergies, schedule an appointment with your doctor and find out what she can do to help! There are many interventions before considering allergy shots- though for severe sufferers, those shots may be an excellent option.