Ask Dr. Etingin: What Causes Hives?; Diminished Sense of Smell

Several weeks ago I broke out in hives. What exactly are hives, and what causes them?

Hives are an outbreak of red bumps, patches, or welts on the skin that appear suddenly. They usually itch and sometimes can sting or burn. They can appear anywhere on the body, including the face, lips, tongue, throat, or ears, and can vary in size and shape. Different factors—including allergies, chemicals in foods, insect stings, certain medications, and hormone imbalances can cause hives. Menopause can be responsible for an outbreak of hives because menopause causes imbalances between the two most important hormones in a woman’s body: progesterone and estrogen. Autoimmune diseases, such as thyroid disease, lupus, and celiac disease, can also cause hormonal imbalances that lead to hives.

It’s often difficult to determine the exact cause of hives. There’s no specific test for hives, so you will have to work with your physician to try to figure out what is causing them. The doctor will probably take a medical history and ask about foods you’ve eaten recently and medications you’re taking. Preventing a future breakout of hives will depend on what is causing them. For example, if you’re having a reaction to a certain food, your doctor may advise you to avoid eating that food. If the hives are caused by medication, ask about alternative treatments. Antihistamines may offer relief from hives. If your hives become a regular problem, your doctor may advise you to take an antihistamine on a regular basis to prevent future outbreaks. When you have hives, if you experience chest pain or difficulty breathing, seek medical attention immediately, as this could be a severe allergic reaction called anaphylaxis that causes your throat or tongue to swell up and block your airway.

A visit to your doctor or an allergist can help get to the bottom of what caused your case of hives, and develop a plan for how to prevent or manage potential future outbreaks.

My sense of smell is not as strong as it used to be. Is this a sign of something serious?

As people age, they often experience a natural decline in various sensory functions, including the sense of smell. While this is a common part of the aging process, there are also numerous medical conditions that may be responsible for the changes to your sense of smell. Neurological conditions such as Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis can affect the nerves involved in the sense of smell. In fact, about 90 percent of people with Parkinson’s disease (PD) lose their sense of smell. But a diminished sense of smell does not necessarily mean you have one of these neurological conditions. There are many other things that can affect your sense of smell. For instance, nasal polyps, which are noncancerous growths in the sinuses, can obstruct airflow and impair the sense of smell, and sinusitis (inflammation of the sinuses) can block the nasal passages and lead to a diminished sense of smell. And COVID, as you probably know, reduced some people’s ability to smell while symptoms were active, and in some cases even after they recovered.

There are also medications that can affect the sense of smell. Some medications that are commonly associated with smell disturbances include over-the-counter nasal decongestants, which can cause temporary loss of smell with prolonged or excessive use. Intranasal corticosteroids, which are often used to treat conditions like allergic rhinitis or nasal polyps, can also sometimes cause changes in smell perception. If medication is responsible for your loss of smell, discontinuing the medication may lead to improvement or resolution of symptoms. However, it’s essential to do this under the guidance of a health-care provider, because abruptly stopping certain medications can have adverse effects. Schedule an appointment with your doctor or with an ear, nose, and throat specialist so the cause of your reduced sense of smell can be identified and treated.

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