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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.

Q. Due to nasal allergies, I sometimes have thick nasal mucus that is really bothersome. Is there something I can do to relieve this without a prescription?

A. An easy home remedy that can help with thick mucus in the nose and sinuses is called "saline lavage," also sometimes called "saline rinse." Saline is essentially salt water.

All you need is a teaspoon of non-iodized salt, a pinch of baking soda, a cup of body-temperature distilled water and an ear bulb syringe – the same kind used to clear out a baby's nose. (Neti pots and other devices can also be used to deliver this saline solution, but you should discuss with your physician first.) Note that homemade saline solution should be freshly made each time it is used!

Mix the salt and baking soda in the warm water. Squeeze this mixture into the ear bulb syringe, and then gently squirt it up into each nostril. If you sniff it instead, you may experience a burning sensation, although this technique may help loosen some of the mucus. The fluid will then run back out your nose or, if your head is tilted back, down the back of your throat. Do this (over a sink) to both sides of your nose.

Don't overdo it! Unless your physician instructs you otherwise, it is best to only to lavage two (or fewer) times a day.