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Q. I have a serious allergy with hives which make me very itchy. I’ve had the hives for the last 10-15 years. Sometimes it goes away for a few years, but it came back this year. When the hives began I took EVIL, and then one doctor suggested ALLEGRA-150. After some time, my doctor suggested ALLEGRA-180. This year, ALLEGRA stopped working on my hives. Now he has given me PETADIN and some antibiotics. Any suggestions to help me get this under control?

A. Chronic urticaria (hives) can be very frustrating and challenging to control. Nonsedating anti-H1 antihistamines are the mainstay of treatment for chronic urticaria. If these agents are ineffective, higher dosages may be tried, or other agents such as sedating antihistamines, anti-inflammatory agents, and sulfones may be attempted. For many urticaria patients, avoidance of mental stress, alcohol, nonsteroidal anti-inflammatory drugs (NSAIDs), and tight-fitting garments is recommended. You should discuss your symptoms, an evaluation tailored to you, and potential strategies for managing symptoms with your allergist.

Q. Will oral antihistamines take care of all my allergy symptoms?

A. Oral antihistamines relieve many of the allergy symptoms by blocking histamine, the chemical "culprit" that causes many symptoms.

Antihistamines are classified by number – depending on what antihistamine receptor is blocked on cells – as H1, H2, and (more recently discovered) H3 and H4. The H1 and H4 receptors are associated with capillaries and nerves, such as in the nose or skin, and H2 receptors are found in the lining of the stomach.

Even the best antihistamines do not offer anything in terms of permanent relief, nor do they relieve nasal congestion. Rather, they temporarily relieve symptoms such as: sneezing, itching, nasal drainage and hives.

Older (first generation) antihistamines tend to have drawbacks that include being short-acting (measured in hours), and causing drowsiness, making it difficult to concentrate. Newer (second generation) antihistamines, many of which are now over the counter, are not as likely to cause this problem. Most of us think of histamine negatively, since we associate it with allergic reactions. However, histamine is actually a chemical which helps nerve cells communicate, allowing our brains to work properly. An antihistamine, therefore, can block the normal way our brains function (causing those side effects). Newer antihistamines, fortunately, do not get into the brain as readily, and so you may experience less side effects while taking them.