MEN'S HEALTH MATTERSUnless symptoms are associated with food, then food allergy is very unlikely, writes Thomas Lynch
QI am 30 years old and saw my doctor because of swelling of my face, involving my lips and also around my eyes. This problem has been present on an intermittent basis for several years. The swelling can also involve other sites, including my hands and arms. On occasions I have had an itchy, red rash all over my body. I was told that I might be allergic to something and that we need to identify the cause.
AThis problem, which you describe, is not uncommon. It may be that allergy is responsible. However, if that is the case, the cause of the allergy is usually fairly obvious. Chief suspects as a cause of allergy are foods or drugs. However, nearly always there is a clear-cut relationship between the intake of the food or drug and the development of the swelling or rash.
Usually, the reaction to these substances takes place within an hour of intake and often much quicker - within five or 10 minutes.
In the case of food allergy, a patient will often notice symptoms such as tingling in the mouth or lips within minutes of food ingestion. Unless your symptoms are associated with food, then food allergy is very unlikely.
Likewise, if you are not taking drugs, this eliminates these as a cause. Certain drugs are particularly associated with rash and swelling: these include antibiotics, anti-inflammatories and some drugs used to treat blood pressure.
If this is a long-standing complaint, as you describe, and the "identity'' of a trigger causing it has not been found, it is unlikely that a single specific cause will be found.
The medical term for your skin rash is "urticaria" - which has a typical nettle sting appearance. The term for the skin swelling is "angioedema" and is due to leaking of fluid from blood vessels beneath the skin.
Commonly, a combination of events are involved. These include genetic predisposition, the climate, hormonal levels (especially in women), and viral infections.
When a patient has such a medical condition, it can be very disabling - both from a work and social point of view. It is important to get sound medical advice on how to deal with the problem. This advice will include careful consider- ation about possible triggers of the condition and eliminating these if they are present.
Strong reassurance is also important, as patients may begin to despair about their situation and also worry about how it might become life-threatening, particularly if they have had swelling of the tongue or developed a sensation of choking.
Some patients may have already started to eliminate dietary products and they can be advised to stop this, unless there is good evidence that foods are involved.
Many patients with a history like yours will respond well to the use of anti-histamine drugs. These can be used safely on a long-term basis.
Newer, long-acting anti-histamines are now available and these are often effective in controlling such symptoms. Occasionally, a combination of anti-histamines is used.
If the above approach is not successful in controlling your symptoms, then referral to a specialist with training in immunology or allergic diseases is warranted.
QI had a vasectomy a few months ago and wonder what happens the sperm that my testicles are still producing?
A Vasectomy has no effect on sperm production itself. The testicles continue to generate approximately 50,000 sperm per hour. These sperm will continue to develop and leave the testicles, but their passage up the vas deferens is blocked at the site of the vasectomy.
Under normal circumstances the body absorbs used and unused sperm - whether or not you have had a vasectomy. After a vasectomy the testicles continue to produce millions of sperms every day and these will accumulate in the testicles, epididymis and vas. Although the body absorbs the sperm at a considerable rate the pressure in this closed system may begin to rise due to the continual sperm production.
Rarely some men experience problems with pain, mild swelling, rupture of the epididymal tubules and infections. The vast majority of men, however, have no such problems.
• This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with contributions from Prof Conleth Feighery, consultant immun- ologist, St James's Hospital and Dr Mohamed Abuzakouk, lecturer in Immunology, St James's Hospital, Dublin.
• Please send your questions to healthsupplement@irish-times.ie