DEAR DR. DONOHUE: How can I prevent future gout attacks? I have had three in the past 18 months. I am currently taking 100 mg of allopurinol. I don’t eat liver or kidney, and I don’t consume alcohol. Could nuts in trail mix be the culprit? I eat two oranges daily. Can the citric acid in oranges increase uric acid? Your comments will be greatly appreciated. – T.T.

A rise in blood uric acid brings on a gout attack. Uric acid is in the shape of needlelike crystals. When those crystals penetrate joints, painful swelling results.

Gout medicines come in two varieties. One stops the body from making too much uric acid. Your allopurinol (Zyloprim) is such a medicine, but you’re taking a relatively small dose. If people have normal kidneys, the standard daily dose is 300 mg, triple what you’re taking, and it can go as high as 600 mg a day.

Some people have a form of gout that is better treated by medicines that increase the excretion of uric acid into the urine. Probenecid is an example of that kind of gout medicine. If the level of uric acid in the urine is on the low side, then this kind of medicine is the better gout medicine.

Between attacks, small doses of colchicine, a time-honored gout medicine, or anti-inflammatory drugs like Indocin are good preventive medicines.

Organ meats, like liver and kidney, have lots of purine in them. Purine promotes the formation of uric acid, so keep staying away from such food. Alcohol can also precipitate an attack, especially beer. Eat meat and seafood sparingly. Peas, beans, lentils, spinach, mushrooms and cauliflower are other sources of purine, but vegetables and fruits don’t raise uric acid levels. (I’ve never had lentils. I don’t know what they taste like.) Drink your orange juice and eat your nuts without fear. Low-fat dairy products lower uric acid. Start using them. Weight reduction and exercise also lower the risk for repeat gout attacks.

The gout booklet explains this condition fully. Readers can obtain a copy by writing: Dr. Donohue – No. 302, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have what I believe is an allergy to latex. Can I be desensitized to it? – R.C.

ANSWER: Latex comes from the sap of rubber trees. Symptoms of such an allergy run from swelling, redness and itching with a rash on whatever part of the body comes in contact with latex to serious reactions with labored breathing and a fall in blood pressure.

There is no current way to desensitize people to latex as there is with so many other allergens. Avoidance is the best treatment. When the skin does break out in a latex-induced rash, cortisone creams and ointments, along with an oral antihistamine, can take care of most symptoms.

People who have had a serious latex allergic reaction need to carry with them at all times a kit that contains a syringe of epinephrine (adrenaline) in it. The syringe is self-activated when it is pressed against the skin. They should also wear a bracelet or necklace that says they’re allergic to latex.

Some foods contain the same allergy-provoking proteins in them as are found in latex. People allergic to latex quite often have a cross allergy to these foods, so they should not eat them. Included on the list are bananas, avocados, kiwi, chestnuts, passion fruit and possibly tomatoes.

You should see an allergist. This is a complicated subject, and avoiding latex is complicated. The allergy ought to be proven.

DEAR DR. DONOHUE: Can a person with Lyme disease spread it to another? Our son-in-law has it, and we wonder if our daughter will get it from him. — P.D.

Lyme disease is not spread from person to person. It’s spread from a bite of an infected tick. Your daughter won’t catch it from her husband.

DEAR DR. DONOHUE: In a recent column, you listed the tests to determine clogged heart arteries. I have angina; however, my doctor did not give me a nuclear stress test. He gave me an angiogram. You didn’t mention it. It is the main test in Canada. Please comment. – K.M.

An angiogram is the main test for demonstrating blocked heart arteries throughout the world. It has many other names – coronary artery catheterization, angiography and on and on. The test consists in advancing a catheter – a soft, pliable tube – through a groin artery up and into the heart arteries. Once at that location, the doctor injects dye, and X-rays are taken of the arteries. The X-rays demonstrate any blockage in the arteries and show exactly where that blockage is. Based on that information, doctors treat the obstruction with angioplasty – a ballooned-tipped catheter that smashes the blockage when the balloon is inflated – or with replacement of the blocked artery segment with a graft, a coronary artery revascularization.

You don’t need a nuclear stress test – the exercise treadmill test that involves injecting a radioactive substance and then taking scans of the heart to see how well the radioactive material is distributed by heart arteries. You have had the ultimate test.

Angiograms can be taken in other body arteries. They demonstrate blockages no matter where the artery is located. They’re often used for clogged leg arteries, for example.

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

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