DEAR DR. DONOHUE: I am a 71-year-old woman who travels frequently with her husband. I may have missed a column you wrote on hives. I have had them recur now for a number of years. Enclosed you will find a synopsis of my breakouts and the treatments I have gotten from an allergist and dermatologist.

Most of the time, clothes cover my hives. This week a few appeared on my arms, legs and face. Since February, I have been free of hives for only a few days. One span that was hive-free was the time I took six days of cortisone, and again when I had an infected tooth extracted. I would appreciate any help you can give. — J.O.

ANSWER: Your thorough account of your experience with hives was very interesting. I wish I could have submitted it entirely for the public to read. And the care given to you by your allergist and dermatologist has been excellent. I can’t add much to it.

Everyone thinks of allergy when they experience hives. Chronic hives, however, rarely are due to allergies. Sometimes, they might occur from food allergies, but that, too, is unusual. If you can trace an outbreak to a particular food, you have solved your problem. Soaps, laundry detergents, medicines, pressure from belts or bra straps, hidden infections, sunlight and exposure to cold are other triggers for hive outbreaks.

In your case, relying on daily antihistamines often can stop outbreaks or make them shorter and less bothersome. The Zyrtec (cetirizine) you were taking was effective for quite a while. If it no longer is effective, then switch. An older antihistamine, Chlor-Trimeton (chlorpheniramine), is sedating but can be taken at nighttime so sleep isn’t interrupted by itching. Claritin (loratidine) and Allegra (fexofenadine) can be taken during the day. Sinequan (doxepin) is an antidepressant that has potent antihistamine activity.

About 50 percent of those suffering from chronic hives find relief in one year; another 20 percent, in five years. I hope you are in that 70 percent group.

DEAR DR. DONOHUE: Please explain water pills. Is the water you get rid of different from the water you drink? On a hot day, can you drink as much as you want to stay hydrated? — B.D.

ANSWER: The water you get rid of through taking water pills is urine. It is not the exact same as the water you drink, but it’s mostly water, with dissolved waste material and some minerals in it. Most water pills work by increasing the amount of sodium (salt) excreted into the urine. Sodium takes with it excess body water.

It’s pretty much OK to drink as much as you want on a hot day. You lose a lot of body fluid on such a day by sweating and by panting. Thirst indicates that you need to drink more water, but it’s not always a reliable indicator. Some people have a large water deficit without being thirsty. You can drink most any fluid you want, not just water. Caffeinated beverages might make you urinate, but they don’t make you lose more water than they provide.

DEAR DR. DONOHUE: Our 52-year-old daughter was seen by her heart doctor for her mitral valve condition. She told him she was feeling well, and he ordered a number of tests, including a chest X-ray. The X-ray showed a lung mass. The doctor ordered lung scans, and then, just to be sure everything was OK, a biopsy of the mass. It came back as benign. He believes it is scar tissue and wants another scan in three to six months. We have a hard time accepting this, since she never had any lung injury or illness. Should we seek a second opinion? — J.S.

ANSWER: Your daughter had the ultimate test — a biopsy. A pathologist carefully examined the biopsy tissue with a microscope. No significant illness was found; more importantly, no cancer was seen.

What was seen might be the residual left over from a minor infection that never produced any symptoms.

To play it exceedingly cautiously, your daughter’s doctor wants a follow-up scan to see if the mass changes in size or shape. She’s getting excellent care. I’d stick with this doctor.

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.

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