DEAR DR. ROACH: I have been suffering from cold urticaria for about nine years. It manifests itself in itchy skin or hives, generally from skin contact with the cold — anything below 68 degrees brings mild itching, and hives appear with lower temperatures.

I have tried a few different allergy medications, with 24-hour fexofenadine having the best result. As with other medications, I try to avoid taking it unless I know I will be exposed to lower temperatures. This even might include working out in a commercially air-conditioned environment. Living in the upper Midwest, I take it quite often this time of year.

This year, I have noticed that it is not as effective. Is it better to take this drug or other allergy medications regularly or back to back for a number of days rather than sporadically? Will fexofenadine become less therapeutic depending on use, or is it more likely that my allergy symptoms are getting worse? — G.B.

ANSWER: Urticaria, from Latin roots meaning ”nettles” and ”burning,” are a series of related disorders with the familiar wheals or hives: typically raised, itchy, pale areas of skin over a reddened area underneath. These can be caused by many triggers. For some people, it is food, but in cold urticaria — also called cold contact urticaria — it’s the presence of cold that triggers the response. It can be easily diagnosed by placing a small plastic bag of ice water on the skin, which causes the typical skin reaction. Different people have different temperature thresholds. The primary treatment is avoiding the cold. Unfortunately, that isn’t always possible, especially in colder climes in the winter. Cold water is the strongest stimulus and can be very dangerous to people with cold urticaria.

Antihistamines like fexofenadine (Allegra) are effective at preventing symptoms in many people. Sometimes, very high doses — much higher than recommended — are required for effectiveness. Over time, the dose can be brought down in most people.

Your question is about a phenomenon called tachyphylaxis: the body ”getting used to” a certain dose of a medication, and it becoming less effective over time. This phenomenon is true with many drugs, especially opiates for pain. Fortunately, tachyphylaxis appears to be minimal or nonexistent with antihistamines, so I would recommend continuous use of the fexofenadine, at least during days you cannot avoid contact with the cold. I can’t say why this year seems to be worse, apart from the fact that it has been especially cold this year!

There are additional treatments that can be tried if antihistamines are ineffective. Dermatologists tend to be experts in managing this condition.

DEAR DR. ROACH: I had a colonoscopy last year and an endoscopy this year. Both times, I stopped breathing during the procedure, and they had to bring me out of the anesthesia to get me to breathe. What can I do so this never happens again? It is very scary, and the endoscopy was horrible because I started gagging and trying to throw up because of what was down my throat. — N.B.

ANSWER: In outpatient procedures, such as endoscopy, patients are treated with medication for sedation and pain relief, but they don’t undergo full anesthesia. The medications used can cause decreased breathing, and physicians need experience to safely monitor patients. Some people have much greater needs for medication than others; I suspect you may be one who needs less, and this would be important to share with the medical team before a procedure. Some people may require more careful monitoring by an anesthesiologist, perhaps even in the operating room.

* * *

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.

(c) 2017 North America Syndicate Inc.

All Rights Reserved

DEAR DR. ROACH: I have been suffering from cold urticaria for about nine years. It manifests itself in itchy skin or hives, generally from skin contact with the cold — anything below 68 degrees brings mild itching, and hives appear with lower temperatures.

I have tried a few different allergy medications, with 24-hour fexofenadine having the best result. As with other medications, I try to avoid taking it unless I know I will be exposed to lower temperatures. This even might include working out in a commercially air-conditioned environment. Living in the upper Midwest, I take it quite often this time of year.

This year, I have noticed that it is not as effective. Is it better to take this drug or other allergy medications regularly or back to back for a number of days rather than sporadically? Will fexofenadine become less therapeutic depending on use, or is it more likely that my allergy symptoms are getting worse? — G.B.

ANSWER: Urticaria, from Latin roots meaning ”nettles” and ”burning,” are a series of related disorders with the familiar wheals or hives: typically raised, itchy, pale areas of skin over a reddened area underneath. These can be caused by many triggers. For some people, it is food, but in cold urticaria — also called cold contact urticaria — it’s the presence of cold that triggers the response. It can be easily diagnosed by placing a small plastic bag of ice water on the skin, which causes the typical skin reaction. Different people have different temperature thresholds. The primary treatment is avoiding the cold. Unfortunately, that isn’t always possible, especially in colder climes in the winter. Cold water is the strongest stimulus and can be very dangerous to people with cold urticaria.

Antihistamines like fexofenadine (Allegra) are effective at preventing symptoms in many people. Sometimes, very high doses — much higher than recommended — are required for effectiveness. Over time, the dose can be brought down in most people.

Your question is about a phenomenon called tachyphylaxis: the body ”getting used to” a certain dose of a medication, and it becoming less effective over time. This phenomenon is true with many drugs, especially opiates for pain. Fortunately, tachyphylaxis appears to be minimal or nonexistent with antihistamines, so I would recommend continuous use of the fexofenadine, at least during days you cannot avoid contact with the cold. I can’t say why this year seems to be worse, apart from the fact that it has been especially cold this year!

There are additional treatments that can be tried if antihistamines are ineffective. Dermatologists tend to be experts in managing this condition.

DEAR DR. ROACH: I had a colonoscopy last year and an endoscopy this year. Both times, I stopped breathing during the procedure, and they had to bring me out of the anesthesia to get me to breathe. What can I do so this never happens again? It is very scary, and the endoscopy was horrible because I started gagging and trying to throw up because of what was down my throat. — N.B.

ANSWER: In outpatient procedures, such as endoscopy, patients are treated with medication for sedation and pain relief, but they don’t undergo full anesthesia. The medications used can cause decreased breathing, and physicians need experience to safely monitor patients. Some people have much greater needs for medication than others; I suspect you may be one who needs less, and this would be important to share with the medical team before a procedure. Some people may require more careful monitoring by an anesthesiologist, perhaps even in the operating room.

* * *

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.

(c) 2017 North America Syndicate Inc.

All Rights Reserved

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