How are allergies treated? Is there any permanent cure? I have to live on antihistamines for my rash that keeps flaring up for no apparent reason.

The treatment of an acute allergic reaction will depend on where it occurs, its severity, and its duration. Antihistamine drugs are the mainstay of treatment and may be given by tablet, mixture, injection or cream. They are best used early in the course of an allergic reaction or if an exposure to an allergy-provoking situation is expected. Unfortunately, in past years only sedating antihistamines were available, which caused drowsiness as an unacceptable side effect, but now a wide range of safe and effective non-sedating antihistamines are available.

Once the reaction is established, a severe attack may require steroid tablets or injections, adrenaline injections, or, in very severe cases, emergency resuscitation. Other drugs may be used in specific allergy situations (eg. lung-opening drugs in acute asthma).

There are a number of substances that can be used on a regular basis to prevent certain allergic reactions. These include sodium cromoglycate (Intal and Opticrom) and nedocromil sodium (Tilade—asthma spray only) which may prevent hay fever, asthma and allergic conjunctivitis if used several times a day throughout the allergy season (often spring). They are available as inhalers, nasal sprays and eye drops.

A small number of patients are so allergic to certain substances (eg. bee stings or ant bites) that they must carry an emergency supply of an injectable drug (usually adrenaline) with them at all times, and must inject themselves it they suspect that they have been exposed to the allergic substance.

Once the substances that cause an allergy in an individual have been identified, further episodes of allergic reaction may be prevented by desensitisation. This involves giving extremely small doses of the allergy-causing substance to the patient, and then slowly increasing the dose over many weeks or months until the patient can tolerate the substance at the maximum likely exposure level. The desensitisation is normally given by weekly injections.

If you can find out what is causing your allergy reaction, it may be possible to have a course of desensitisation, and be cured.

I am only 55, but I am having terrible problems with urinary incontinence. Can you help me with this problem?

Embarrassing, unpleasant, uncomfortable, distasteful, offensive, distressing, intolerable and very annoying. Urinary incontinence is all these things, and more, but it is a topic that is never discussed with friends or family, and mentioned to doctors often only after many visits for other more socially acceptable diseases. Incontinence is usually associated with the old man lying semiconscious in a nursing home bed. But it is far more common in women, and many relatively young women in their thirties or earlier can be victims.

Incontinence is the loss of urine from the bladder at times when such loss is not desirable. It can vary from constant bed-wetting, to the occasional dribble when a woman jumps, coughs or laughs.

The most common cause of incontinence is the damage done to the genitals during childbirth, and this is the reason for women being the victims far more frequently than men. Other causes include urinary infections, strokes, confusion in the elderly, bladder injury, epilepsy anddamage to the spinal cord in paraplegics and quadriplegics.

The urethra is the tube that carries urine from the bladder to the outside of the body. In women it is only 1 to 2 cm long. It leaves the bladder at an acute angle, and this angle causes the pressure of the urine inside the bladder to keep the urethra closed. It requires a voluntary muscular effort to open the urethra and allow the urine to escape. The stretching that occurs during childbirth can cause this critical angle to be lost and the urethra to become a straight tube leading from the bladder to the outside. Any pressure put on the bladder, or any significant volume of urine, can then cause incontinence. Unfortunately this straightened tube can also allow bacteria and infection to enter the bladder more easily and cause the pain and discomfort of cystitis (bladder infection).

Because the bladder is controlled by nerves, damage to the nervous system by a stroke or the cutting of the spinal cord in paraplegics may also lead to incontinence.

As with most diseases, the earlier incontinence is treated, the better the results. Prevention is even better than cure. Exercises to strengthen the muscles of the pelvic floor should be undertaken by all women immediately after childbirth. These can also be done in the early stages of incontinence to help control the bladder function as normally as possible. A patient can start by practising stopping and starting the urinary stream several times whenever they go to the toilet. Physiotherapists can teach the finer details of these exercises.

If the problem has progressed beyond control by exercises alone, the options are rather limited. In younger women, an operation to correct the abnormal bladder/urethra angle is usually successful. In older women, a specially shaped rubber ring may be worn inside the vagina to put pressure on the urethra and prevent urine from escaping. These rings must be fitted and regularly checked by a doctor.

In intractable cases it may be necessary to insert a semi-permanent catheter (tube) into a woman’ s bladder that drains urine into a collecting bag. A woman’ s concern about incontinence can become a significant mental problem and a social barrier, and should therefore be treated sooner rather than later.

Men can also have an operation, but it is not as successful as in women. In elderly and paralysed men, it is often more practical to use a collecting bag, as this can be easily attached to the penis.