Allergies and Hives (Urticaria and Angioedema)

Hives, also known as urticaria, are an outbreak of swollen, pale red bumps, patches, or welts on the skin that appear suddenly -- either as a result of allergies, or for other reasons.

Hives usually cause itching, but may also burn or sting. They can appear anywhere on the body, including the face, lips, tongue, throat, or ears. Hives vary in size (from a pencil eraser to a dinner plate), and may join together to form larger areas known as plaques. They can last for hours, or up to several days before fading.

Angioedema is similar to hives, but the swelling occurs beneath the skin instead of on the surface. Angioedema is characterized by deep swelling around the eyes and lips and sometimes of the genitals, hands, and feet. It generally lasts longer than hives, but the swelling usually goes away in less than 24 hours.

Occasionally, severe, prolonged tissue swelling can be disfiguring. Rarely, angioedema of the throat, tongue, or lungs can block the airways, causing difficulty breathing. This may become life threatening.

What Causes Hives and Angioedema?
Hives and angioedema form when, in response to histamine, blood plasma leaks out of small blood vessels in the skin. Histamine is a chemical released from specialized cells along the skin's blood vessels.

Allergic reactions, chemicals in foods, insect stings, sunlight exposure, or medicines can all cause histamine release. Sometimes it's impossible to find out exactly why hives have formed.

There are several different types of hives and angioedema, including:

1. Acute urticaria and/or angiodema: Hives or swelling lasting less than six weeks. The most common causes are foods, medicines, latex, or infections. Insect bites and internal disease may also be responsible. The most common foods that cause hives are nuts, chocolate, fish, tomatoes, eggs, fresh berries, soy, wheat, and milk. Fresh foods cause hives more often than cooked foods. Certain food additives and preservatives may also be to blame. Medicines that can cause hives and angioedema include aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs, such as ibuprofen), high blood pressure medications (ACE inhibitors), or painkillers such as codeine.
2. Chronic urticaria and/or angioedema: Hives or swelling lasting more than six weeks. The cause of this type of hives is usually more difficult to identify than those causing acute urticaria and/or angioedema. The causes can be similar to those of acute urticaria but can also include autoimmunity, chronic infections, hormonal disorders, and malignancy.
3. Physical urticaria: Hives caused by direct physical stimulation of the skin -- for example, cold, heat, sun exposure, vibration, pressure, sweating, and exercise. The hives usually occur right where the skin was stimulated and rarely appear anywhere else. Most of the hives appear within one hour after exposure.
4. Dermatographism: Hives that form after firmly stroking or scratching the skin. These hives can also occur along with other forms of urticaria.
5. Hereditary angioedema: This is painful swelling of tissue. It is passed on through families.

How Are Hives and Angioedema Diagnosed?
Your doctor will need to ask many questions in an attempt to find the possible cause of hives or angiodema. Since there are no specific tests for hives -- or the associated swelling of angioedema -- testing will depend on your medical history and a thorough examination by your primary care doctor, allergist, immunologist, or dermatologist.

Skin tests may be performed to determine the substance that you are allergic to. Routine blood tests are done to determine if a system-wide illness is present.

What Is the Treatment for Hives and Angioedema?
The best treatment for hives and angioedema is to identify and remove the trigger, but this is not an easy task. Antihistamines are usually prescribed by your doctor or dermatologist to provide relief from symptoms. These drugs may also be taken on a regular schedule to help prevent hives and associated swelling from forming in the first place.

Chronic hives may be treated with antihistamines or a combination of medications. When antihistamines don't provide relief, oral corticosteroids may be prescribed. For severe hive or angioedema outbreaks, an injection of epinephrine or a steroid medication may be needed.

How Can Hives Be Managed?
While you're waiting for the hives and swelling to disappear, here are some tips:

• Avoid hot water; use lukewarm water instead.
• Use gentle, mild soap.
• Apply cool compresses or wet cloths to the affected areas.
• Try to work and sleep in a cool room.
• Wear loose-fitting lightweight clothes.

When Should I Call the Doctor About Hives or Angiodema?
If hives or angioedema occur with any of the following symptoms, contact your doctor right away:

• Dizziness
• Wheezing
• Difficulty breathing
• Tightness in the chest
• Swelling of the tongue, lips, or face

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Mental Health and Psychotherapy

Psychotherapy is often used either alone or in combination with medications to treat mental illnesses. Called "therapy" for short, the word psychotherapy actually involves a variety of treatment techniques. During psychotherapy, a person with a mental illness talks to a licensed and trained mental health care professional who helps him or her identify and work through the factors that may be triggering their illness.

How Does Psychotherapy Help?

Psychotherapy helps people with a mental disorder:

• Understand the behaviors, emotions, and ideas that contribute to his or her illness.
• Understand and identify the life problems or events -- like a major illness, a death in the family, a loss of a job, or a divorce -- that contribute to their illness and help them understand which aspects of those problems they may be able to solve or improve.
• Regain a sense of control and pleasure in life.
• Learn coping techniques and problem-solving skills.

Types of Therapy
Therapy can be given in a variety of formats, including:

• Individual: This therapy involves only the patient and the therapist.
• Group: Two or more patients may participate in therapy at the same time. Patients are able to share experiences and learn that others feel the same way, and have had the same experiences.
• Marital/couples: This type of therapy helps spouses and partners understand why their loved one has a mental disorder, what changes in communication and behaviors can help, and what they can do to cope.
• Family: Because family is a key part of the team that helps people with mental illness get better, it is sometimes helpful for family members to understand what their loved one is going through, how they themselves can cope, and what they can do to help.

Approaches to Therapy
While therapy can be done in different formats -- like family, group, and individual -- there are also several different approaches that mental health professionals can take to provide therapy. After talking with the patient about their disorder, the therapist will decide which approach to use based on the suspected underlying factors contributing to the condition.

Different approaches to therapy include:

Psychodynamic Therapy
Psychodynamic therapy is based on the assumption that a person is mentally ill because of unresolved, generally unconscious conflicts, often stemming from childhood. The goal of this type of therapy is for the patient to understand and cope better with these feelings by talking about the experiences. Psychodynamic therapy is administered over a period of three to four months, although it can last longer, even years.

Interpersonal Therapy
Interpersonal therapy focuses on the behaviors and interactions a patient has with family and friends. The primary goal of this therapy is to improve communication skills and increase self-esteem during a short period of time. It usually lasts three to four months and works well for depression caused by mourning, relationship conflicts, major life events, and social isolation.

Psychodynamic and interpersonal therapies help patients resolve mental illness caused by:

• Loss (grief)
• Relationship conflicts
• Role transitions (such as becoming a mother, or a caregiver)

Cognitive-Behavioral Therapy
Cognitive-behavioral therapy helps people with mental illness to identify and change inaccurate perceptions that they may have of themselves and the world around them. The therapist helps the patient establish new ways of thinking by directing attention to both the "wrong" and "right" assumptions they make about themselves and others.

Cognitive-behavioral therapy is recommended for patients:

• Who think and behave in ways that trigger and perpetuate mental illness.
• With mild-to-moderate depression as the only treatment or in addition to treatment with antidepressant medication
• Who refuse or are unable to take antidepressant medication.
• Of all ages who have mental illness that causes suffering, disability, or interpersonal problems.

Therapy Tips
Therapy works best when you attend all of your scheduled appointments. The effectiveness of therapy depends on your active participation. It requires time, effort, and regularity.

As you begin therapy, establish some goals with your therapist. Then spend time periodically reviewing your progress with your therapist. If you don't like your therapist's approach or if you don't think the therapist is helping you, talk to him or her about it and seek a second opinion if both you and your therapist agree, but don't discontinue therapy abruptly.
Tips for Starting Therapy

Here are some tips to use when starting therapy for the first time:

• Identify sources of stress: Try keeping a journal and note stressful as well as positive events.
• Restructure priorities: Emphasize positive, effective behavior.
• Make time for recreational and pleasurable activities.
• Communicate: Explain and assert your needs to someone you trust; write in a journal to express your feelings.
• Try to focus on positive outcomes and finding methods for reducing and managing stress.

Remember, therapy involves evaluating your thoughts and behaviors, identifying stresses that contribute to your condition, and working to modify both. People who actively participate in therapy recover more quickly and have fewer relapses.

Also, keep in mind, therapy is treatment that addresses specific causes of mental illness; it is not a "quick fix." It takes longer to begin to work than medication, but there is evidence to suggest that its effects last longer. Medication may be needed immediately in cases of severe mental illness, but the combination of therapy and medicine is very effective.

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Food Allergies and Food Intolerance

Food allergies or food intolerances affect nearly everyone at some point. People often have an unpleasant reaction to something they ate and wonder if they have a food allergy. One out of three people either say that they have a food allergy or that they modify the family diet because a family member is suspected of having a food allergy. But only about 3% of children have clinically proven allergic reactions to foods. In adults, the prevalence of food allergy drops to about 1% of the total population.

This difference between the clinically proven prevalence of food allergy and the public perception of the problem is in part due to reactions called "food intolerances" rather than food allergies. A food allergy, or hypersensitivity, is an abnormal response to a food that is triggered by the immune system. The immune system is not responsible for the symptoms of a food intolerance, even though these symptoms can resemble those of a food allergy.

It is extremely important for people who have true food allergies to identify them and prevent allergic reactions to food because these reactions can cause devastating illness and, in some cases, be fatal.

How Food Allergies Work

Food allergies involve two features of the human immune response. One is the production of immunoglobulin E (IgE), a type of protein called an antibody that circulates through the blood. The other is the mast cell, a specific cell that occurs in all body tissues but is especially common in areas of the body that are typical sites of allergic reactions, including the nose and throat, lungs, skin, and gastrointestinal tract.

The ability of a given individual to form IgE against something as benign as food is an inherited predisposition. Generally, such people come from families in which allergies are common -- not necessarily food allergies but perhaps hay fever, asthma, or hives. Someone with two allergic parents is more likely to develop food allergies than someone with one allergic parent.

Before an allergic reaction can occur, a person who is predisposed to form IgE to foods first has to be exposed to the food. As this food is digested, it triggers certain cells to produce specific IgE in large amounts. The IgE is then released and attaches to the surface of mast cells. The next time the person eats that food, it interacts with specific IgE on the surface of the mast cells and triggers the cells to release chemicals such as histamine. Depending upon the tissue in which they are released, these chemicals will cause a person to have various food allergy symptoms. If the mast cells release chemicals in the ears, nose, and throat, a person may feel an itching in the mouth and may have trouble breathing or swallowing. If the affected mast cells are in the gastrointestinal tract, the person may have abdominal pain or diarrhea. The chemicals released by skin mast cells, in contrast, can prompt hives.

Food allergens (the food fragments responsible for an allergic reaction) are proteins within the food that usually are not broken down by the heat of cooking or by stomach acids or enzymes that digest food. As a result, they survive to cross the gastrointestinal lining, enter the bloodstream, and go to target organs, causing allergic reactions throughout the body.

The complex process of digestion affects the timing and the location of an allergic reaction. If people are allergic to a particular food, for example, they may first experience itching in the mouth as they start to eat the food. After the food is digested in the stomach, abdominal symptoms such as vomiting, diarrhea, or pain may start. When the food allergens enter and travel through the bloodstream, they can cause a drop in blood pressure. As the allergens reach the skin, they can induce hives or eczema, or when they reach the lungs, they may cause asthma. All of this takes place within a few minutes to an hour.

Which Food Allergies Are Most Common?

In adults, the most common foods allergies include: shellfish such as shrimp, crayfish, lobster, and crab; peanuts (a legume that is one of the chief foods to cause severe anaphylaxis, a sudden drop in blood pressure that can be fatal if not treated quickly); tree nuts such as walnuts; fish; and eggs.

In children, the food allergy pattern is somewhat different. The most common food allergens that cause problems in children are eggs, milk, and peanuts. Adults usually do not lose their allergies, but children can sometimes outgrow them. Children are more likely to outgrow allergies to milk or soy than allergies to peanuts, fish, or shrimp.

The foods that adults or children react to are those foods they eat often. In Japan, for example, rice allergy is more frequent. In Scandinavia, codfish allergy is more common.

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Blueberry Juice May Boost Memory

Drinking Wild Blueberry Juice Improves Memory and Learning in Older People With Age-Related Memory Decline

Blueberry Benefits

Researchers say blueberries contain a wealth of phytochemicals that have antioxidant and anti-inflammatory effects. In addition, animal studies have shown that the polyphenols found in blueberries, anthocyanins, have been shown to increase signaling in brain centers associated with memory as well as improve how the brain gets rid of glucose, all of which may help slow memory decline.

In the study, researchers looked at the effects of drinking wild blueberry juice on memory decline in nine adults in their 70s who were experiencing age-related memory decline problems, such as memory lapses.

The participants drank about two and a half cups each day of blueberry juice made from commercially available frozen wild blueberries for 12 weeks. A comparison group of seven older adults drank a similar amount of placebo non-juice beverage for the same time period.

Researchers conducted memory tests, such as word association and list learning and recall tasks, at the beginning and end of the study.

The results showed that those who drank blueberry juice showed significant improvement on learning and memory tests compared to the placebo group.

Researchers say there were also trends suggesting reduced symptoms of depression and lower glucose levels among the wild blueberry juice drinkers, but further research will be needed to confirm these results.

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