Few children outgrow tree-nut allergies

DEAR DR. ROACH: Can you tell me if there is any hope of a cure for tree-nut allergy, particularly for a child? – X.M.

ANSWER: Tree-nut allergies, like all allergies, vary in severity from mild to life-threatening. Allergies to tree nuts (these include walnuts, cashews, almonds and others) are common, are more likely to be severe, and tend to persist throughout a lifetime. People with one tree-nut allergy may have others, and about 30 percent to 40 percent also may be allergic to peanuts (despite their being legumes, they share enough characteristics for co-allergic reactions). Peanut and tree-nut allergies appear to be increasing in prevalence over time.

The mainstay of treatment is avoiding the allergen, which requires constant vigilance, careful reading of nutritional labels and a plan for treatment in case of ingestion, such as an epinephrine auto-injector.

Only about 15 to 20 percent of younger children will develop tolerance to ("outgrow") their allergy; an allergy that develops later in life usually is life-long. Your allergist can do skin testing to see if the allergy is resolving.

DEAR DR. ROACH: I'm a retired ob-gyn and am married to a practicing MD. I'm writing you today about autism and its use as a diagnosis. My view is that each individual is unique, mentally and physically. While autism may be one way to describe a personality, each person must deal with the world on its terms, not because of a diagnosis.

I personally believe I am a variant of Asperger's, but who knows? I don't qualify as having Asperger's if given a test prepared by psychologists/psychiatrists. Yet, I have had many life experiences that are best explained by an Asperger's diagnosis. What are your thoughts on Asperger's syndrome? – A.G.

ANSWER: Since I recently published a letter by an adult who believed he was autistic despite never having received a diagnosis, I have had several letters like this.

Autism, including its variant Asperger syndrome, is a spectrum of illnesses that share deficits in social interaction, communication and stereotyped, repetitive behaviors. In Asperger syndrome, there is no clinically significant delay in language and intellectual development.

I certainly agree with you that each person is unique and that the label of a psychiatric condition, such as autism, bipolar or a personality disorder, has only limited usefulness. In the best case, it can give a person a way to start learning how to overcome challenges that similar people have faced. At worst, a label predisposes others to look at the person through a certain lens and to expect certain behaviors.

I have had many patients with psychiatric diagnoses ask me not to put that into their medical record, after having built up enough trust to share the diagnosis with me. People have had such negative experiences based on their diagnosis, their label, that I don't blame them for wanting to avoid being stereotyped. There is so much variation in all of these conditions — even in those of us considered neurologically typical — that we need to recognize the good and the bad side of making such a diagnosis.

DEAR DR. ROACH: For the past year, I have had hives on and off again, with the hives being more prominent in the morning than in the evening. I have been told by a dermatologist that it is a viral infection and that topical creams, antihistamines and/or steroids would only mask the virus; it would still be in my bloodstream.

Are there other causes of hives that could be causing or exacerbating the problem? I do not know the exact cause of the hives, and they really don't itch too much; they are just unsightly. How long can a viral infection with hives take to clear up? Is there anything I can do to help speed along recovery? Can it be heat-related, as in the warmer months they tend to come out more than in the winter?

I get differing diagnoses from various doctors, some saying I shouldn't go swimming or go outside in the sun, and others saying to go about my normal routines. I just wish I knew the exact cause. I would be grateful for any advice or insight on the topic of hives. – Anon.

ANSWER: "Chronic urticaria" is the medical term for what you are describing, if you have hives most days of the week for six or more weeks. The rash is raised, usually round or ring-shaped, and can vary in size. They tend to be very itchy (you are lucky that way), and each lesion comes and goes within 24 hours. Chronic urticaria is common, occurs more often in women, and can appear on any part of the body. Sunlight and heat can be triggers for some people, whereas cold is a trigger for others. Diet usually is not a factor in chronic urticaria.

There are many theories, but nobody is sure, so I can't tell you the exact cause. It probably is not due to viruses, but hepatitis A and hepatitis C have been suggested, though there is conflicting data. We don't know what causes it, but since the itchiness can be very uncomfortable, even severe in some cases, I think treatment, even though it may "mask" the underlying cause, is still helpful, and antihistamines are the mainstay of treatment. I tend to prefer cetirizine (Zyrtec), since it is effective (both for itchiness and in helping clear the hives), usually doesn't cause sedation and is very inexpensive as a generic. It may take two to five years, but chronic urticaria usually does go away eventually.

DEAR DR. ROACH: I haven't had to shave my legs for a few years, because I never get growth anymore. My doctor said it may be from hormones. I'm 78. Could that be the reason? – C.K.

ANSWER: Lack of hair can result from several reasons, including hormonal changes, but also from "poor circulation" — specifically, peripheral artery disease. Unrecognized peripheral artery disease is important, since it predicts increased risk of heart disease and stroke. A physical exam is sometimes enough to make the diagnosis; however, if your doctor's suspicion is high, he or she might order a Doppler ultrasound to evaluate the blood flow.

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 [email protected]. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.

(c) 2016 North America Synd., Inc.

All Rights Reserved