READER’S HIVES LIKELY CAUSED BY ALLERGIC REACTION

Question: I broke out with a rash around my neck a few weeks ago. I figured it was from my necklace, but now I am getting hives on my arms, too. What can be causing these hives? What can I do to get rid of them?

Answer: Hives, known clinically as “urticaria,” are generally an acute allergic reaction to a substance, although sometimes the source of the rash can be hard to determine. While allergies most commonly appear during childhood, they can develop at any age.

Hives can last for a few minutes or up to several days. An individual hive usually only lasts for less than 24 hours, but hives can spread. Acute urticaria is defined as an episode lasting less than six weeks.

Although sometimes an illness like mono can cause hives, they usual form through allergic reactions to foods, medications or insect stings. The usual suspects include nuts, shellfish, fresh berries, chocolate and tomatoes, as well as penicillin-based antibiotics, aspirin, high-blood-pressure medications, and painkillers such as codeine. These cases usually resolve quickly once you stop consuming the offending food or medication.

Chronic urticaria is defined as hives that last more than six weeks. Their cause can be difficult to identify. Up to 50 percent of the time, the cause is never understood, and these are called chronic idiopathic urticaria.

Regardless of the cause, hives occur when your body releases a chemical called histamine, and in response, blood platelets leak out of small blood vessels. Hives appear as swollen red or white bumps on the skin. They usually itch, but they can also burn and sting. Scratching will make the itching and swelling worse, as can exercise, sweating and emotional stress.

Identifying the cause of a single episode of hives is probably not worth the time. However, when hives appear frequently, you should have testing done to determine the cause. Your family physician can often diagnose an allergy based on a medical history. It’s important to note what foods and/or medications you consumed before each hive outbreak.

If the cause is known, treatment for urticaria is aimed at prevention and avoidance. If the cause is not known, short-term steroid pills and creams and/or oral antihistamines may be prescribed by your physician to stop the itching.

You can find over-the-counter oral antihistamines to treat hives as well as topical creams such as Benadryl. You may also be able to gain some relief through colloidal oatmeal treatments or simply by applying cold compresses or damp, cool cloths to the affected area. I would also suggest wearing light, loose-fitting cloths.

Lastly, and most importantly, if your hives are ever accompanied by difficulty breathing, tightness in the chest, dizziness or swelling in the face, seek emergency medical care.

AVOIDING HOLIDAY EXCESS EASIER THAN LOSING WEIGHT LATER

Question: I love the holiday season, but I hate to see it coming because I always gain ten pounds (or more), which is difficult to lose. I try to starve myself, but that doesn’t seem to work. How can I keep this from happening? 

Answer: “Eat, drink and be merry” sounds like fun, and it is possible to do all three, but for most of us, it takes a little planning and self-control. Many people wait until they have already gained the holiday weight and then try to figure out how to lose it. Keeping it off to start with is a much better holiday plan. Here are some helpful tips.

First of all, keep in mind the old mantra, “everything in moderation.” Whether it is food or drink, it is always best to pace yourself. Keep in mind that you may attend various holiday parties; you don’t have to overindulge at every one. Even if you manage to avoid the parties, people will inevitably bring holiday treats into the workplace. What’s more, people typically make their highest-calorie dishes only for the holidays. Don’t deny yourself these treats, but do keep portions small. With every little indulgence, remind yourself that plenty more sweet and rich delights will come your way this season –- you do not need to go overboard. It’s a good idea to assess the goodies at the party and strategize about how you want to treat yourself:  look for the healthier items.

To ensure that there will be healthier items, bring them yourself. Arrange a colorful fruit or veggie platter with a low-calorie yogurt dip so that you can join the group while eating healthy. 

If you are going to a party, eat a nutritious snack before you go. You may even have a light dinner if the party is late. Lean meat, low-fat cheese or something else that is protein-based will stay in your stomach longer and keep you from feeling hungry. Try to stay out of the kitchen or the part of the room where most of the food is.

If you are going to a holiday dinner, try to avoid the gravy and dressing, and only take a small slice of cake or pie. Drink water with your meal or snacks, and limit the amount of alcohol you consume. Most alcoholic drinks have almost 200 calories per serving, so just a few can equal all of your daily calorie requirements. Create your own wine sparkler by adding carbonated water to a glass of wine.

Finally, and most importantly, make time to exercise.  This will help you keep weight off and stress levels down.  Even if you can’t do your full workout, some exercise is better than none. Even an occasional quick walk will help you avoid extra holiday pounds. If bad weather prevents outdoor exercise, look into getting a seasonal gym membership or swim a few laps at a local indoor pool. 

Finally, when you are at a get-together, visit more and eat less. Enjoy the people and the atmosphere instead of focusing on the food. Happy Holidays!

MEDICATION BENEFITS MUST OUTWEIGH SIDE-EFFECTS

Question: Recently I was taking an over-the-counter cold medicine, and I started experiencing pain in my back. A friend said that when she took the same pill, it made her back hurt, too. I stopped taking the pill, and my back quit hurting. This was not listed on the package as a side-effect. Should I ever take this pill again? Will this side-effect hurt me?

Answer: This is a very interesting question, since all medications produce side-effects. The side-effects can range from very mild to life threatening. When taking any medication, either prescription or over-the-counter, make sure the benefits outweigh the risk of harm from the medication. If you doubt that a medication is worth taking considering its possible risks, discuss the matter with a pharmacist or your family physician, who knows your personal medical history and your experience with the drug.     

Typically, the most serious side-effect of a medicine is an allergic reaction. Allergic reactions can range from very mild, like a slight rash, to life threatening. A life-threatening allergic reaction causes swelling of the face and airways, associated with difficulty breathing and/or wheezing. This type of reaction can come on very quickly after taking a medication and requires immediate medical attention in an emergency room. These reactions are treated with antihistamines and steroids, often administered intravenously. If you have a severe reaction to a medication, be sure to notify your family physician and your pharmacist to make sure that your allergy to the medication is noted in your medical file and on your allergy list at your pharmacy. You should not take that medication ever again. There also may be similar medications that could cause the same reaction. Your pharmacist can help you identify and avoid those drugs.

As for all other medication side-effects, most are just a bother, but some are an indication to stop taking the particular medication or modify the dose. Most side-effects cause little harm, but fatigue or rapid heartbeat may lead your physician to change or alter the dosage.

Ideally, your doctor will try a different medication rather than making you put up with uncomfortable side-effects, but sometimes there is no alternative medication.  Some medicines, like blood thinners for certain conditions, are necessary, regardless of the side-effects they cause.  If your physician determines that the benefit outweighs any risks or potential annoyance you face from taking the medication, you must learn to live with the side-effects. 

Never stop taking prescriptions without first consulting a physician. Instead, make an appointment with your primary care doctor to discuss your prescription side-effects.  For over-the-counter medications, describe the problem to your local pharmacist and ask for recommended alternatives.

DR. SIMPSON’S SEARCH FOR BEST CANNOLI RECIPE

Each year around the holidays, I publish a special recipe blog. The recipes do not have medicinal value --nor typically, are they very healthy.  But it’s the holiday season, and physician or not, I know that we all indulge a bit this time of year. So here it is: my annual indulgence-in-moderation plug.

This fall, I had the good fortune to visit Sicily. While there, I ate the best cannoli I have ever had. Of course, this dish originated in Sicily, so I should not have been surprised that they were so tasty. Cannoli means “little tubes” in Italian, and they are just that: crispy pastry tubes that contain a sweetened ricotta cheese filling. 

Since my return home, I have tried several recipes in an effort to replicate these fantastic-tasting cannoli. 

I decided to start with the filling and buy the pastry tubes, although neither is too hard to make. These treats are not particularly good for the waistline, but they are wonderful for the taste buds.

The shells are made from pastry dough that is rolled very thin, wrapped around a metal tube and deep-fried briefly until brown. Again, several recipes can be found online and in cookbooks, but pre-made cannoli shells can also be purchased at many supermarkets.

As for the filling, many recipes are available, but I think I have found the perfect combination of ingredients. This recipe is very simple.

Cannoli Filling

1 pound of ricotta—whole milk

½ to ¾ cup sugar

1 teaspoon vanilla extract

Beat all three ingredients until smooth. The sweetness of this recipe is up to you. In Europe, desserts and pastries are often not as sweet as ours in the U.S., so you may want a little more sugar to suit your taste and that of your family and friends. 

After the filling is made, I put it in a plastic bag, cut one corner off and squeeze this into the premade cannoli tubes, filling from each end. 

Some recipe variations use powdered sugar instead of granulated sugar, but I think the filling is lighter with the granulated sugar. Also, some people mix chocolate mini chips, chocolate shavings or candied lemon into the filling. 

Top the cannoli with red and green sprinkles to turn them into a creative holiday dessert. I like to sprinkle powdered sugar on top, but I am told that classic cannoli have chopped pistachios on the creamy ends. 

Have fun trying out this Italian treat. (Now I just may have to go back to Sicily to be sure I have the recipe correct!)