DEAR DR. DONOHUE: I have had hives for almost three years. They pop up anywhere on my body. Sometimes my hands swell, too. I have seen a dermatologist, an allergist and a rheumatologist. Nothing has worked so far. Do you have any ideas? – D.F.

ANSWER: Allergies, medicines such as ACE inhibitors and anti-inflammatory drugs, thyroid-gland disorders, parasite infections and illnesses like lupus are some of the hidden causes of recurrent crops of hives. You have seen three specialists, all of whom are familiar with these possibilities, and the doctors were not able to find any of them. That’s not unusual. It’s often impossible to pinpoint the cause of chronic hives. And the hand-swelling is also not unusual. It’s called angioedema, and is a common counterpart to recurrent hives. The swelling can happen in many different body areas.

About 50 percent of people with chronic hives are free of them in one year, treated or not. Twenty percent have to contend with them for more than 20 years. I hope you fall on the briefer end of that spectrum.

You have tried antihistamines. But have you tried them in combination with medicines like Tagamet or Zantac? Those are medicines whose primary purpose is to reduce the production of stomach acid. However, they have an antihistamine effect, too, and the combination of an ordinary antihistamine and one of these drugs can turn the corner for some hive sufferers. The combination has to be used on a regular basis, not just when there is a hive outbreak.

Leukotriene-receptor blockers are used for asthma. Leukotrienes are body compounds involved in allergic reactions, and the blockers can also be used for people with chronic hives. Two such drugs are Singulair and Accolate, and they have met with some success in controlling chronic hives.

DEAR DR. DONOHUE: The doctor tells me I have vasculitis. Please explain it and its treatment. – L.R.

ANSWER: Vasculitis questions, of which there are quite a few, aren’t easy to answer. The word means “blood vessel inflammation.” That’s straightforward. Vessel inflammation impedes the flow of blood to organs. That is straightforward. What isn’t so straightforward is the fact that there are at least 17 different vasculitis varieties. Each has its own set of symptoms. Each depends on which blood vessels are inflamed and which organ or organs are affected. And each might have a unique treatment. Adding confusion to the topic is that vasculitis can exist on its own or be associated with another illness.

Biopsy of an affected blood vessel is often the way that the diagnosis is made.

One somewhat common vasculitis illness is idiopathic cutaneous vasculitis. It causes outbreaks of various skin manifestations – bruises, hives or ulcers – and the legs are the place where it usually shows up.

For all the different vasculitis varieties, prednisone is often the preferred treatment. It is one of medicine’s most potent anti-inflammatory drugs.

If your doctor can give you a name for the kind of vasculitis you have, give me that information. I can provide you with more details.

DEAR DR. DONOHUE: I have slightly high blood pressure, and I wonder if I could safely get by treating it without medicines. I have an inborn aversion to them. Can you give me any facts that support my position? – J.A.

ANSWER: If blood pressure is just a bit high and if it has caused no organ damage (eye, kidney, heart, blood vessels), then a person can try lowering it without immediate recourse to medicines. A five-to-10-pound weight loss brings about a substantial reduction in blood pressure. Cutting back on sodium can lower it by two to eight points. Daily exercise can also bring it down two to nine points. A person with high blood pressure also has to moderate the use of alcohol.

The combined effects of these measures are not inconsequential and can help many people confront high blood pressure without drugs. See what your doctor says.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.