Ocean swimming alters skin microbiome, increasing vulnerability to infection

Swimming in the ocean alters the skin microbiome and may increase the likelihood of infection, according to research presented at ASM Microbe 2019, the annual meeting of the American Society for Microbiology.

“Our data demonstrate for the first time that ocean water exposure can alter the diversity and composition of the human skin microbiome,” said Marisa Chattman Nielsen, MS, a PhD student at the University of California, Irvine, the lead author on the study. While swimming normal resident bacteria were washed off while ocean bacteria were deposited onto the skin.”

The researchers detected ocean bacteria on all participants after air drying and at six and 24 hours post-swim, but some participants had acquired more ocean bacteria and/or had them persist for longer.

The research was motivated by previous studies which have shown associations between ocean swimming and infections, and by the high prevalence of poor water quality at many beaches, due to wastewater and storm water runoff. Recent research has demonstrated that changes in the microbiome can leave the host susceptible to infection, and influence disease states. Exposure to these waters can cause gastrointestinal and respiratory illness, ear infections, and skin infections.

The investigators sought 9 volunteers at a beach who met criteria of no sunscreen use, infrequent exposure to the ocean, no bathing within the last 12 hours, and no antibiotics during the previous six months. The researchers swabbed the participants on the back of the calf before they entered the water, and again after subjects had air dried completely following a ten-minute swim and at six and 24 hours post swim.

Before swimming, all individuals had different communities from one-another, but after swimming, they all had similar communities on their skin, which were completely different from the “before swim” communities. At six hours post swim, the microbiomes had begun to revert to their pre-swim composition, and at 24 hours, they were far along in that process.

“One very interesting finding was that Vibrio species — only identified to the genus level — were detected on every participant after swimming in the ocean, and air drying,” said. Nielsen. (The Vibrio genus includes the bacterium that causes cholera.) At six hours post swim, they were still present on most of the volunteers, but by 24 hours, they were present only on one individual.

“While many Vibrio are not pathogenic, the fact that we recovered them on the skin after swimming demonstrates that pathogenic Vibrio species could potentially persist on the skin after swimming,” said Nielsen. The fraction of Vibrio species detected on human skin was more than 10 times greater than the fraction in the ocean water sample, suggesting a specific affinity for attachment to human skin.

Skin is the body’s first line of defense, both physically and immunologically, during exposure to contaminated water. “Recent studies have shown that human skin microbiome plays an important role in immune system function, localized and systemic diseases, and infection,” said Nielsen. “A healthy microbiome protects the host from colonization and infection by opportunistic and pathogenic microbes.”

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Materials provided by American Society for Microbiology. Note: Content may be edited for style and length.

Skinny self-image, heavy workouts in adolescence are warning signs, study shows

Adolescents who see themselves as puny and who exercise to gain weight may be at risk of so-called muscularity-oriented disordered eating behaviors, say researchers led by UCSF Benioff Children’s Hospitals.

The researchers found that 22 percent of males and 5 percent of females ages 18-to-24 exhibit these disordered eating behaviors, which are defined as including at least one of the following: eating more or differently to gain weight or bulk up, and use of dietary supplements or anabolic steroids to achieve the same goal.

Left unchecked, these behaviors may escalate to muscle dysmorphia, characterized by rigid diet, obsessive over-exercising and extreme preoccupation with physique, say the researchers in their study publishing in the International Journal of Eating Disorders on June 20, 2019.

“Some eating disorders can be challenging to diagnose,” said first author Jason Nagata, MD, of the UCSF Division of Adolescent and Young Adult Medicine. “Unlike anorexia nervosa, which may be easily identified by parents or pediatricians, disordered eating to increase bulk may masquerade as healthy habits and because of this, it tends to go unnoticed.”

Heart Failure, Depression, Social Isolation in Worst Cases

At its most extreme, it can lead to heart failure due to insufficient calories and overexertion, as well as muscle dysmorphia, which is associated with social withdrawal and depression, Nagata said.

The 14,891 young adults in the study, who came from throughout the United States, had been followed for seven years. The researchers wanted to see if the early data, when the participants’ average age was 15, revealed something about their perceptions and habits that may serve as warning signs.

They found that boys who exercised specifically to gain weight had 142 percent higher odds of this type of disordered eating; among girls, the odds were increased by 248 percent. Boys who perceived themselves as being underweight had 56 percent higher odds; in girls the odds were 271 percent higher. Smoking and alcohol use in boys, and smoking in girls, increased odds moderately.

Additionally, being of black race bolstered odds by 66 percent in boys and 181 percent in girls.

Non-heterosexual identity, which the participants had been asked about when they reached adulthood, was not found to be a risk factor, the researchers said.

In young adulthood, 6.9 percent of males reported supplement use to gain weight or build muscle and 2.8 percent said they used anabolic steroids. Use by young women was significantly lower at 0.7 percent and 0.4 percent respectively.

“Supplements are a black box, since they are not regulated,” noted Nagata. “In extreme cases, supplements can cause liver and kidney damage. Anabolic steroids can cause both long-term and short-term health issues, including shrunken testicles, stunted growth and heart disease.”

Nagata said that clues that indicate behaviors may approach muscle dysmorphia include a highly restrictive diet that omits fats and carbohydrates, compulsive weighing and checking of appearance, and extensive time dedicated to exercise that may cut into social activities.

Co-authors: Senior author is Scott Griffiths, PhD, of Melbourne School of Physiological Sciences, University of Melbourne, in Australia. Co-authors are Stuart B. Murray, PhD, Kristen Bibbins-Domingo, PhD, MD, MAS, and Andrea Garber, PhD, RD, of UCSF; and Deborah Mitchison, PhD, of Macquarie University and Western Sydney University, in Australia.

Funding: Nagata is a participant in the Pediatric Scientist Development Program funded by the American Academy of Pediatrics and the American Pediatric Society; Murray was supported by the National Institutes of Mental Health; Garber was supported by the National Institutes of Health; and Griffiths is supported by a National Health and Medical Research Council Early Career Fellowship and a University of Melbourne Early Career Grant.

Summer Depression Is a Thing—Here’s How to Deal

Every year, despite knowing better, I’m surprised that my depression doesn’t magically disappear in the summer. In the winter, sure, of course I’m depressed! It’s cold and dark and all too easy to roll up in a blanket burrito and hibernate. But summer is supposed to be happy. Who cares if I know logically that that’s not how depression works? When the sun’s out and everyone is having fun, the heavy blanket of depression can feel like it’s downright mocking me.

Turns out it’s completely normal to experience summertime sadness that can manifest in a number of ways. A lot of it has to do with the expectation that summer will basically “fix” everything, Guy Winch, Ph.D., clinical psychologist and author of Emotional First Aid, tells SELF. “For some people, it’s very common to wait and wait and wait for summer, but when summer arrives, they realize they had this big fantasy around it. They think, ‘When summer comes, I’ll do all these things and have all these experiences!’ and when that doesn’t materialize, they feel worse.”

Also, some people just hate the summer, which is reason enough to feel awful. In some places, summer is a sweaty, stinky, humid hellscape. The days may turn sluggish, opportunities to feel insecure are around every corner, FOMO rears its ugly head, and sometimes, it seems like everyone else is having the time of their lives while you’re sitting at home in front of the fan.

But all of the above is different from actually feeling depressed—or more depressed—as the weather heats up. In my case, realizing that my depression doesn’t take a summer vacation just makes everything worse.

Some people also deal with a condition known as summer-onset seasonal affective disorder (commonly referred to as reverse SAD or summer SAD), a type of depression that follows a seasonal pattern specific to the spring and summer. Unfortunately, we don’t know exactly what’s going on when seasonal changes send our moods out of whack, Norman Rosenthal, M.D., psychiatrist and the first researcher to describe and name SAD, tells SELF, but there are theories, mostly related to a person’s tolerance for heat or ambient light (we’ll get to that later). The important difference between SAD and other types of depression is that it follows a seasonal pattern, meaning that symptoms are present in certain months (in this case, summer) but completely absent in others. If this isn’t an experience that’s unique to the summer for you, there’s also a chance that it’s a case of major depressive disorder that’s just getting worse in the summer. This is the more likely option if you’re dealing with feelings of sadness and lethargy, because the most common symptoms associated with summer SAD are irritability, poor appetite, insomnia, agitation, restlessness, and anxiety.

No matter why you’re feeling shitty in the summer—whether it’s summer SAD , good ol’ year-round clinical depression, or certain aspects of the season bringing you down—taking care of yourself isn’t exactly intuitive. In winter, there’s advice like getting a sunlamp and making sure to go outside—but what are you supposed to do in the summer when seemingly everyone else is frolicking around unburdened by this totally unseasonal gloom? Luckily, experts have some tips:

1. Acknowledge that this is a thing.

If you’ve noticed this pattern of getting depressed—or more depressed—in the summer, recognizing its seasonality can help you understand the factors that make you feel worse and how you might be able to reverse them. “Depression is depression whenever it occurs and can be treated with many of the same methods, but if it occurs in a special season, that might give you some valuable clues on how to address it,” says Dr. Rosenthal. “You want to take advantage of every piece of information you have.” For instance, maybe it would make sense to schedule extra therapy appointments during the summer if possible.

There’s also value in putting a name to your experience. So many people have positive associations with summer that it’s easy to beat yourself up for being “dramatic” or think that you’re imagining things. Reminding yourself, “OK, this is something real that happens to me,” can offer solace and validation.

2. Drop the image of what summer is “supposed” to look like.

One of the crappy things about summer is that some people have leftover associations from childhood that are so much better than the reality of summer as an adult, says Winch. Like, if your idea of summer used to mean freedom, fun, activities, and endless days, obviously spending the season doing your normal thing absolutely sucks in comparison.

Even if you don’t have all these warm fuzzy memories of summer, you might be hard-pressed to escape messaging about you what summer “should” look like: beaches, swimming, parties, BBQs, fireworks, blah, blah, blah. If you’re feeling pressure to make sure your summer lives up to all of that, first ask yourself if you even like all of that. It can be really helpful to take some time to consider what your ideal summer actually looks like and then find others who feel the same way, says Winch. If your idea of a perfect summer is avoiding the sun at all costs, blasting the A/C, and catching up on all your favorite shows, you’re not alone. (In fact, I’ll join you!)

Of course, if you’re drawn to the makings of a “typical” summer season but it’s not in the cards for you for whatever reason, the idea of lowering your expectations can feel impossible. Telling yourself that it’s OK not to have your dream summer doesn’t magically erase your desire to have that experience. But resolving to do your best not to ruminate on expectations you can’t meet can be freeing, says Winch. Something that can make a big difference here is taking social media with a big, fat grain of salt—remember that people put their best lives forward on social media, and it’s very unlikely that someone is actually having the Best Summer Ever even if it looks that way on Instagram.

3. Be proactive about meeting your own expectations.

All of that said, having expectations isn’t necessarily a bad thing, says Winch. A lot of the time, people have certain expectations for the summer—going to the beach, hanging out with friends, catching up on reading, whatever—and they totally have the ability to meet them. They just…don’t. It happens! Summer is a lethargic season and the call of staying inside in front of your A/C can be so, so seductive. Plus, life doesn’t stop for summer just because we want it to.

But if you know you’re someone who always gets let down by their own expectations, you have to be proactive. “You have to set up the kinds of circumstances that will allow you to enjoy the things you were expecting to enjoy,” says Winch. So if your idea of a great summer is the possibility of a summer fling, you might have to dust off those dating apps, or if you want to make it to the beach, you might have to be the one to rally your friends and make the plan.

If you just read this tip and found yourself thinking, “Wow, easier said than done,” because being proactive truly feels impossible, that’s a possible sign that what you’re dealing with falls outside of summer blues and into depression or summer SAD territory.

4. Stay cool.

Though there hasn’t been a ton of research on the causes of summer-onset SAD specifically, heat is an obvious suspect when considering contributing factors. Various studies have linked high temperatures with depressed and agitated moods and increased mental health emergencies. As researchers have theorized, part of this may come down to heat stress, or basically the various ways that being way too hot can tax the human body and mind. Hotter temperatures can also contribute to poor sleeping patterns, make people feel like they need to stay cooped up inside even if they’d rather be out, and create other factors that can impact mental health.

On top of that, some people might be less tolerant of heat than others. Although the reasons why aren’t clear, Dr. Rosenthal says it possibly comes from problems with the body’s ability to maintain homeostasis. In order to sustain homeostasis, there are multiple systems and mechanisms for stabilizing our internal environments against changing variables—like shivering when it’s cold in order to warm up, or sweating when it’s hot.

“It’s very likely that for some people dealing with summer depression, one or more of these systems isn’t working the way that it should,” says Dr. Rosenthal.

It’s hard to draw the connection definitively since summer SAD is still seriously unresearched compared to its more common winter counterpart, but it’s worth testing whether keeping cool eases any of your depressive symptoms. Many of Dr. Rosenthal’s summer SAD patients find relief spending time somewhere with an A/C, swimming in pools or natural bodies of water, or even taking occasional cold showers, he says.

5. Consider reducing your exposure to light.

This might be surprising, considering that sunlight and light therapy are so commonly suggested to ease depression symptoms, but for some people, light has the opposite effect, says Dr. Rosenthal. There are many reasons why someone might have an adverse reaction to increased light—underlying health issues that cause light sensitivity, for example—but your reaction to light could be another culprit behind your summer sadness. Without a wealth of research, it’s kind of a “the chicken or the egg” type of dilemma—you might feel depressed because of your light sensitivity, or you might be sensitive to light because of your depression. But either way, it’s worth seeing if addressing the issue will help your symptoms.

“These people [might] benefit from dark glasses, blackout shades in their bedroom, and other measures that reduce the amount of ambient light,” says Dr. Rosenthal. Of course, it’s worth noting that this will require some experimentation—there’s no guaranteeing that light sensitivity is what’s causing you trouble. Give blackout shades a try, but ditch them if you find your symptoms getting worse.

6. Try not to isolate yourself.

Social contact is important for your mental health year-round, and summer can be a particularly grueling time to deal with loneliness or isolation. Remember those annoyingly common summer expectations? So many of them place an emphasis on social connectedness: flings, BBQs, parties, the 4th of July, Labor Day weekend.

According to Winch, loneliness can feed on itself, and it’s easy to get stuck in a hard cycle. Even if putting yourself out there is easier said than done, pushing yourself a little might really help you feel better. This could mean being the one to reach out to friends, especially for events when you might feel left out and crappy if you wind up missing out, like the 4th of July. If that sounds like a total nightmare, I get it, but consider this: So often, we’re quick to assume that other people will initiate plans and that if they wanted to see us, they would hit us up. But guess what? A lot of people really suck at making plans. And there’s a good chance they’re following your line of thinking and waiting for you to reach out to them for the same reason. Get how it can be a vicious cycle?

Of course, there will also be times our social life isn’t exactly thriving and we’re left wondering who the heck we should even reach out to in the first place. We’ve all been there—psychologists are calling loneliness an epidemic for a reason. Even if that’s the case, it might still really help to try to be around people, says Winch—go to an event, walk around, volunteer, hang out in public spaces. Doing these things alone might feel weird at first, but for a lot of people, it gets easier, even enjoyable. Just don’t be afraid to start small. Like, there’s no need to jump straight to solo dining, which is definitely at least a level three experience. On the other hand, reading a book in the park is pretty emotionally low-risk.

If just being around people doesn’t scratch the lonely itch, there are also options for actually meeting and hanging out with new people during the summer. Think: sports leagues, summer classes, local Meetups, etc.

7. Know when to seek help.

Tips like these are meant to help you, but it’s always, always important to recognize that they might not be enough. Like Dr. Rosenthal said, depression is depression no matter when you’re dealing with it, and a lot of the time, you can benefit tremendously by treating depression with the help of a professional, whether that’s seeing a therapist, talking to a doctor about medication, or both.

It can be difficult to know when it’s time to seek out help, but Winch has a good rule of thumb. “If you have an idea of what might make you feel better, like seeing friends or going outside, but you’re just not able to motivate yourself, it’s probably a good idea to speak to someone,” he says. These things are important to pay attention to, because you want to know when this feeling is having an impact on your life—like getting in the way of things you used to enjoy and holding you back from your usual routine. “It’s about when you feel stuck and defeated,” says Winch.

All that said, you definitely don’t need to reach a certain low before you look into therapy or medication—if it’s a problem you want help with, you can benefit no matter where on the spectrum of depression or general sadness you happen to be. Since finding a therapist can be daunting, this guide to finding affordable therapy and this teletherapy primer might come in handy.


What Causes ITP?

If you’ve ever discovered a mysterious bruise on your body, you’ve probably tried to retrace your steps. Maybe you slammed into that doorknob harder than you thought, or maybe stumbling to the bathroom in the dark for a midnight pee break was a bad idea. But if you have the bleeding disorder immune thrombocytopenia (also known as idiopathic thrombocytopenic purpura or just ITP), you might find yourself wondering where the hell this new bruise came from way too often.

Bruising is a common sign of ITP, as are symptoms like petechiae (small dots of blood that look like a skin rash), sudden bloody noses, gums that bleed out of nowhere, and more, according to the National Heart, Lung, and Blood Institute (NHLBI). But what causes someone to get this disorder in the first place? Let’s take a look at what experts know about ITP causes—and what they don’t.

ITP happens when your immune system accidentally targets platelets.

As you might already know, your immune system is your body’s basic line of defense against disease. When your body perceives a threat, like the influenza virus your coworker just sprayed into the air via a forceful sneeze, your body ideally produces an immune response to neutralize it. Hats off to the human body for this super useful mechanism. But, unfortunately, your immune system isn’t infallible, meaning it can accidentally interpret something that’s not harmful—or something that’s even helpful—as a threat, which experts believe is what happens with ITP.

If you have ITP, it means your immune system targets platelets, which are cells in your body that cause blood to stick together (or clot), the NHLBI explains. If someone doesn’t have ITP and gets a cut, their body directs platelets to the wound to form a clot that helps stop the bleeding. Clearly, if your body is attacking such a useful component of your blood, things can get a little tricky.

For some context, the average platelet count for adults is between 150,000 to 450,000 per cubic millimeter of blood. If someone’s platelet count falls below 100,000 per cubic millimeter of blood and doctors cannot pinpoint an external cause like medications, they can be diagnosed with ITP. That doesn’t necessarily mean they’d experience symptoms, though. That appears to be more of an issue for people with platelet levels that fall below 50,000.

ITP is a relatively rare blood disorder, with estimates in the American Journal of Hematology suggesting that 3.3 per 100,000 adults receive an ITP diagnosis annually and that anywhere from 1.9 to 6.4 per 100,000 children are diagnosed each year.

A bacterial or viral infection can trigger ITP.

Before we dive into that, quick note: ITP can be acute, meaning symptoms last for six months or fewer, or it can be chronic, which is when symptoms last more than six months, according to the NHLBI.

Many ITP cases, especially those that occur in children, are acute ones that happen after a viral infection like the mumps or the flu, the Mayo Clinic says. This is because as the body is trying to fight off the infection, it might also start destroying platelets, Elizabeth Roman M.D., a pediatric hematologist and oncologist at New York University Langone Health, tells SELF.

It’s not just kids: Adult patients sometimes mention that they had some kind of infection before getting diagnosed with ITP, Rahki Naik, M.D., M.H.S., associate director of hematology and oncology fellowship program at Johns Hopkins Medicine, tells SELF. Infections like HIV and hepatitis can trigger the illness, as can H. pylori (a bacteria that causes stomach ulcers), the Mayo Clinic says. However, when adults are diagnosed with ITP, the onset is often spontaneous and the condition tends to be chronic, Dr. Naik explains.

Other autoimmune disorders can be a factor as well.

We already know that ITP can be either acute or chronic, but it can also be broken down into two other categories. With primary ITP, no other disorders or causes are present. Secondary ITP, on the other hand, means the disorder occurs alongside other autoimmune disorders like lupus, which is a condition where the body attacks tissue and organs, Sjorgen’s Syndrome, which occurs when the body attacks the glands that make tears and saliva, and seemingly in rarer cases, rheumatoid arthritis, which is when the body attacks its own tissues including joints.

In a 2016 retrospective study published in Medicine, researchers looked at 85 ITP patients in a rheumatology department and found that 33 of those patients had lupus, 16 of them had Sjogren’s Syndrome, and three had rheumatoid arthritis.

It isn’t clear why autoimmune disorders happen alongside ITP, but it’s not super surprising since ITP basically comes about when your immune system goes rogue.

And FYI: Pregnancy can exacerbate symptoms.

Anyone who’s been pregnant knows that there’s pretty much no end to how many ways your body can change throughout the process. As it turns out, ITP can become more intense than usual during pregnancy, according to the Merck Manual. It’s unclear exactly what causes this reaction primarily because pregnant people tend to experience other conditions that might result in platelet loss, including gestational thrombocytopenia, which is when a pregnant person’s blood platelet count falls for no apparent reason, and preeclampsia, which is a blood pressure condition that can also contribute to lower platelet levels.

Treating ITP depends on the cause.

ITP has a surprisingly great prognosis for many people: Most children recover spontaneously within six months of diagnosis, and many adults with chronic ITP find that their symptoms normalize spontaneously within five years, according to the Merck Manual. So, if you have mild ITP, your doctor might not recommend any treatment and simply wait to see if your body decides to boost your platelet count over time. But if you have a more severe form of ITP, your doctor might recommend treatment.

There isn’t a cure for ITP, which can be frustrating, but there are various medications out there to increase platelet counts or calm your immune system, according to the Mayo Clinic. If your body isn’t responsive to medication, your doctor might recommend a splenectomy, which is a surgery to remove your spleen (which is mainly what creates the antibodies that attack platelets), the NHLBI explains.

If you have a bacterial or viral infection, the NHLBI says that doctors might attempt to treat that in the hopes that your platelet count will rise. Similarly, in cases where secondary ITP is present, treatment varies depending on the underlying illness.

When it comes to pregnancy and ITP, doctors are most concerned with managing the increased risk of heavy bleeding during delivery, according to the Mayo Clinic. Your doctor may decide to give you a medication to temporarily increase your platelet levels before childbirth, the Merck Manual explains.

No matter exactly what’s causing your ITP, it’s generally a manageable illness. Talking to your doctor can help you maintain your quality of life—and cut back on those annoying random bruises as much as possible.


Dissemination of pathogenic bacteria by university student’s cell phones

New research has demonstrated the presence of S. aureus in 40% of the cell phones of students sampled at a university. S. aureus is a common cause of hospital and community-based infections and is currently considered an important pathogen because of its level of antibiotic resistance. The research, conducted at the Western University of São Paulo, Brazil, is presented at ASM Microbe, the annual meeting of the American Society for Microbiology.

Of the bacteria isolated, 85% were resistant to the antibiotic penicillin and 50% had the ability to adhere to surfaces. In addition, the presence of genes related to adhesion, antimicrobial resistance and toxins were present a high level. Samples were collected from 100 cell phones of students from the Biomedicine (20), Pharmacy (20), Dentistry (20), Nutrition (20), and Nursing (20) courses. The vast majority of the bacteria isolated belonged to students of the nursing course.

Nursing students are very likely to become carriers of S. aureus since clinical practice in hospital settings is part of their coursework and exposure to occupational hazards is inherent to this setting, which could favor the colonization and contamination of the surface of cell devices. Cell phones used in healthcare environments allow for the transmission of bacteria that harbor genes of virulence and resistance, contributing to increasing the infection rates as well as an increase in the morbidity/mortality from these infections.

“The widespread use of cell devices in hospitals and healthcare settings has raised major concerns about nosocomial infections, especially in areas requiring the highest standards of hygiene, such as the operating room,” said Lizziane Kretli, Professor at the Western University of São Paulo, Brazil. Students in the health area attend practical classes and clinical stages where they have direct contact with samples, objects, and clinical environments containing pathogenic microorganisms.

Cell phones are an indispensable accessory in the professional and social life of a large part of the population. In the medical field they are considered an integral part of the life of health professionals and have improved communication, collaboration, and information sharing.

“In this context, cell phones may thus serve as a reservoir of bacteria known to cause nosocomial infections and could play a role in their transmission to patients through the hands of health professionals,” said Kretli.

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Materials provided by American Society for Microbiology. Note: Content may be edited for style and length.

Foodie calls: Dating for a free meal (rather than a relationship)

When it comes to getting a date, there’s any number of ways people can present themselves and their interests. One of the newer phenomena is a “foodie call” where a person sets up a date with someone they are not romantically interested in, for the purpose of getting a free meal. New research finds that 23 — 33% of women in an online study say they’ve engaged in a “foodie call.”

Upon further analysis, the social and personality psychology researchers found that women who scored high on the “dark triad” of personality traits (i.e., psychopathy, Machiavellianism, narcissism), as well as expressed traditional gender role beliefs, were most likely to engage in a foodie call and find it acceptable.

The research, by Brian Collisson, Jennifer Howell, and Trista Harig of Azusa Pacific University and UC Merced, appears in the journal Social Psychological and Personality Science.

In the first study, 820 women were recruited, with 40% reporting they were single, 33% married, and 27% saying they were in a committed relationship but not married. Out of them, 85% said they were heterosexual, and they were the focus for this study.

The women answered a series of questions that measured their personality traits, beliefs about gender roles, and their foodie call history. They were also asked if they thought a foodie call was socially acceptable.

23% of women in this first group revealed they’d engaged in a foodie call. Most did so occasionally or rarely. Although women who had engaged in a foodie call believed it was more acceptable, most women believed foodie calls were extremely to moderately unacceptable.

The second study analyzed a similar set of questions of 357 heterosexual women and found 33% had engaged in a foodie call. It is important to note, however, that neither of these studies recruited representative samples of women, so we cannot know if these percentages are accurate for women in general.

For both groups, those that engaged in foodie calls scored higher in the “dark triad” personality traits.

“Several dark traits have been linked to deceptive and exploitative behavior in romantic relationships, such as one-night stands, faking an orgasm, or sending unsolicited sexual pictures,” says Collisson.

Collisson and Harig said they became interested in the subject of foodie calls after reading about the phenomenon in the news.

As for how many foodies calls might be occurring in the United States, Collisson says that can’t be inferred from the current research.

“They could be more prevalent, for instance, if women lied or misremembered their foodie calls to maintain a positive view of their dating history,” says Collisson.

The researchers also note that foodie calls could occur in many types of relationships, and could be perpetrated by all genders.

Ageism reduced by education, intergenerational contact

Researchers at Cornell University have shown for the first time that it is possible to reduce ageist attitudes, prejudices and stereotypes through education and intergenerational contact.

Ageism is the most socially acceptable prejudice on the planet, according to the World Health Organization (WHO). Discrimination against a person because of their age is more normalized than even racism or sexism. The WHO, which recruited the Cornell-led team to do the study, will use the research to inform its anti-ageism strategy.

According to the team of researchers, programs that foster intergenerational contact, combined with education about the aging process and its misconceptions, worked best at reducing ageist attitudes. The interventions had the greatest impact on women, teens and young adults. Their study was published in the American Journal of Public Health.

“The most surprising thing was how well some of these programs seemed to work,” said co-author Karl Pillemer, professor of human development at Cornell and gerontology in medicine at Weill Cornell Medicine. “If we teach people more about aging — if they’re less scared of it, less negative about it and less uncomfortable interacting with older people — that helps.”

Macro- and micro-aggressions, such as workplace discrimination and ageist jokes in movies, can have serious negative effects on the mental and physical health of older people. Physicians with ageist attitudes may misdiagnose their older patients or exclude them from particular treatments.

Older people tend to adopt society’s negative attitudes toward aging — and those who do are more likely to experience psychological distress and physical illness. They even die 7.5 years sooner on average than those who have a more positive attitude about aging, Pillemer said.

Researchers analyzed 63 studies, conducted between 1976 and 2018, with a total of 6,124 participants. The studies evaluated three types of interventions that aimed to curb ageism: education, intergenerational contact, and a combination of the two.

The most successful programs combined both education and intergenerational contact. Importantly, Pillemer said, these interventions are both low-cost and easy to replicate.

“Volunteer organizations and after-school programs should think about involving some of these methods to reduce ageist attitudes because they actually seem to work,” he said.

The WHO will use the research to create an upcoming global report on ageism.

“We know from past experience that these reports can be particularly effective at raising awareness, generate more political will on a topic and provide an evidence based framework for global and local action,” said Alana Officer, who leads the WHO’s campaign against ageism. “I hope that the Cornell-led research will help change the world for the better.”

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Materials provided by Cornell University. Original written by Susan Kelley. Note: Content may be edited for style and length.

What to Consider If You Have to Travel for an Abortion

Getting an abortion is a safe and legal procedure in this country, but it’s becoming harder and harder to access one. If you’re reading this, you’re probably very aware of the many obstacles that can stand in the way of someone getting an abortion. And those barriers just keep piling up.

At least 378 abortion restrictions were introduced in the first half of 2019 alone, according to the Guttmacher Institute. The intention behind these restrictions is clear: to effectively ban abortion by outlawing the procedures after six weeks of gestation (the time since your last period), which is usually before most people even find out they’re pregnant. Lawmakers in Georgia, Kentucky, Mississippi, Ohio, Louisiana, and Missouri voted in favor of such six-week bans. Alabama intends to outlaw abortion unless the life or health of the pregnant person is endangered.

But remember this: None of these extreme bans have actually gone into effect. What’s more, groups like the American Civil Liberties Union (ACLU) and Planned Parenthood Federation of America (PPFA) are fighting these unjust proposals, which are ultimately meant to challenge Roe v. Wade in the Supreme Court with the hopes of overturning it. There are also plenty of groups doing intense advocacy work at the national level to safeguard abortion, like All* Above All, the National Latina Institute for Reproductive Health, the National Asian Pacific American Women’s Forum, and In Our Own Voices.

But we know—and you probably know, too—that abortion is already really difficult to access in many parts of the country, especially for people living in rural areas or in states with laws that forced some abortion-providing health centers to close. Five states (Kentucky, Mississippi, Missouri, North Dakota, and South Dakota) have just one abortion clinic left. In 2014, 90 percent of U.S. counties had no clinics providing abortion care, according to the Guttmacher Institute’s most recent Abortion Provider Census.

As a result, many people needing abortions “are forced to delay care and travel hundreds of miles or even out-of-state to access a procedure,” Gillian Dean, senior director of medical services at PPFA, tells SELF. According to a 2017 analysis of census data published in The Lancet Public Health, 20 percent of U.S. people would have had to travel 42 miles or more to get an abortion in 2014. And people living in vast swaths of middle America states like Montana, Wyoming, North Dakota, South Dakota, Nebraska, and Kansas would have had to trek at least 180 miles to the nearest clinic, according to the report. If any of the recently proposed abortion bans go into effect, even more people will be forced to travel across state lines to access an abortion.

All of this is to say that it is a particularly scary and frustrating time to be someone who is pregnant and doesn’t want to be, especially if you’re not in a position to quickly and easily access an abortion. Your mind is probably filled with questions like, Where do I go? How am I getting there? And how am I paying for all of this? It’s an overwhelming logistical nightmare that no one should have to sort through.

We know there’s already a lot on your mind if you’re up against these arbitrary obstacles. So, we put together a list of some of the most important considerations for anyone who needs to travel to get an abortion. Plus, some resources you can rely on along the way. Hopefully, this will make it all a little bit easier.

1. Find out how far along you are.

Your gestational age will likely inform where you can go to get an abortion. So the first thing you’ll want to do is find out how far along you are in your pregnancy and how far along you will be by the time you are able to get an abortion.

Forty-three states have laws prohibiting abortion after a certain point in the pregnancy, according to the Guttmacher Institute. Most are set at 20 to 24 weeks or fetus viability (the point at which a fetus can survive outside the uterus, around 24 to 28 weeks) and typically provide for exceptions when the pregnant person’s health is endangered. If you are past the cutoff in your state, you’ll have to travel to another one to get a safe and legal abortion. (Since around 90 percent of abortions happen in the first trimester, this won’t apply to most people looking to end a pregnancy now—but it could if the aforementioned restrictive bans went into effect.) Find out the gestational limits in your state and nearby states here.

How long you’ve been pregnant also determines which of the two kinds of abortions you can get. The first is called a medication or medical abortion (i.e., “the abortion pill”), which is approved by the Food and Drug Administration (FDA) until the 10-week mark of gestation. After this point, you will need to get an in-clinic (i.e., surgical) abortion, the American College of Obstetricians and Gynecologists (ACOG) explains. Here’s more detail about exactly how each type of abortion works.

If you’re at the point where you can get either abortion, talking to a doctor can help you make the best choice for you, The Very Reverend Katherine Ragsdale, interim president and CEO of the National Abortion Federation (NAF), tells SELF.

Whichever type you choose, know that abortion is a safe medical procedure as long as it’s performed by a licensed medical professional. As ACOG notes, an abortion in the first trimester is one of the safest medical procedures you can get.

2. Consider if telemedicine abortion is an option for you.

Theoretically, the wonders of modern medicine mean that anyone eligible for a medication abortion via telemedicine should be able to get one. In this scenario, you would typically go to a local clinic, meet with an on-site staffer to confirm the pregnancy, and have a virtual consultation with a medical professional who is licensed to perform abortions. They would explain the process, answer your questions, and you would receive the medication to end your pregnancy. You can read more about what telemedicine abortion can look like here, but the gist is that it could eliminate the need for further travel and hassle. Telemedicine abortion has also been shown to be just as safe and effective as a traditional medication abortion, as SELF previously reported.

The problem is that 17 states require the health care provider administering the medication abortion to be physically present, according to the Guttmacher Institute, effectively outlawing telemedicine abortion in those states. And even if medication abortion via telemedicine is legal in your state, clinics may not offer it. Take a look at the Guttmacher Institute’s chart outlining the laws state-by-state and get in touch with your local abortion-providing health center to learn if you have access to telemedicine abortion.

3. Know that your state may have laws on mandatory counseling.

Thirty-four states require people seeking an abortion to receive some kind of counseling prior to the procedure, either in-person or in the form of written or digital materials, according to the Guttmacher Institute. Twenty-nine of these states also dictate exactly what information must be included. Keep in mind that a lot of this information is intended to provide you with inaccurate information that has zero basis in scientific evidence and that can influence your decision.

For instance, five states require that the patient is given inaccurate information about what the National Cancer Institute has determined is a nonexistent link between abortion and breast cancer, according to the Guttmacher Institute. When Nicole S., 34, had a medication abortion at 8.5 weeks gestation in December 2017, her doctor was legally required to tell her that personhood begins at conception, which ACOG notes is trying to place a legal definition on a medical situation. (Medically, pregnancy does not begin until a fertilized egg implants into the uterine lining.) Nicole, a consultant, PPFA hotline volunteer, and bartender traveled from her home in Kentucky to an abortion clinic in Indiana because the procedure was considerably cheaper there. Between the mandatory counseling and the required ultrasound, the overarching message Nicole got, she tells SELF, was that she should continue the pregnancy. She decided to move forward with her abortion.

The Guttmacher Institute makes it easy to read up on the counseling requirements in the state you’re going to so that you’re prepared for what you’re going to hear, including the possibility of being fed biased, false information under the guise of medical advice.

4. Your state may also have a mandatory waiting period.

Twenty-seven states require people seeking abortions to wait a certain amount of time (usually 24, 48, or 72 hours) between receiving mandatory counseling and getting the procedure, according to the Guttmacher Institute. (All 50 states waive the mandatory waiting period in the case of a medical emergency or when the patient’s life or health is threatened.)

If you’re able to get the written materials ahead of time, you may only have to make one trip. (Some states allow you to get the materials beforehand in the mail, over the phone, digitally, or even via fax.) But in 14 states, the laws require both in-person counseling and a waiting period, which means you’ll have to either travel twice or stay in that area for a decent amount of time. Nicole, for instance, made the seven-hour round-trip from Kentucky to Indiana (where the waiting period is 18 hours) two times.

If you’re trying to figure out what your timeline will look like, call the clinic to find out their scheduling flow depending on local laws, staffing, and other factors. “Clinics have different routines set up to make this as smooth as possible for both [the patients] jumping through hoops and the providers,” Ragsdale says.

Waiting periods can also change your decision about where to go for your abortion in the first place, Ragsdale explains. If you could go to two different states, waiting periods (or a lack thereof) in each one might help you make your choice.

5. Consider how you’re getting there and whether you’re staying overnight.

The mode of transportation that makes the most sense time- and money-wise depends on where you live and where you’re going. If you live in one of those 14 states that require you to visit the clinic twice over a certain timeframe, it might make sense for you to stay in the area overnight based on various factors.

If you need help locking in transportation or housing, Ragsdale says that NAF counselors can try to connect you with volunteers that will give you a ride or let you stay in their homes, as well as local hotels that provide reduced rates for people in town to get an abortion. The National Network of Abortion Funds (NNAF) may also be able to connect you with travel and lodging resources through local abortion funds, Dr. Dean says.

One thing to note on the safety front: You might see individuals and small local groups volunteering their time and homes for people coming into town for abortions. These people could very well be good Samaritans, but if you go this route, you run the risk of encountering someone who is anti-choice and/or affiliated with a crisis pregnancy center (CPC), Ragsdale cautions. It’s best to go through major, reputable pro-choice organizations that have already vetted their resources, like The Yellowhammer Fund, which works to remove barriers to access for anyone looking to get an abortion in any of Alabama’s abortion clinics.

6. Keep in mind that you may need to take time off work and coordinate childcare.

Generally you’ll want to take the day of the procedure off work if you can, and maybe the day after, too. (For a medical abortion, that means at least not working the day you take the second pill, which is when symptoms like cramping and bleeding begin.)

A few states have laws on mandatory paid sick days, which can usually be used for an abortion procedure and recovery, according to the NNAF. The National Partnership for Women & Families has a fantastic chart rounding up those statutes. Hotline counselors at resources like PPFA and the NAF should be able to help you figure out local laws, too. If taking paid time off is not an option for you, Dr. Dean recommends reaching out to the NNAF to see if they can help you figure out how to offset the cost of lost wages.

If you have kids (as 59 percent of people seeking abortions do, according to the Guttmacher Institute), there’s the issue of arranging childcare. If you can’t find a friend or family member or afford a babysitter, PPFA and the NAF might be able to connect you with local resources, while the NNAF might be able to help you cover the costs of childcare, Dr. Dean says.

7. You may need or want to bring someone with you.

Some clinics require you to have a companion to escort you home after the procedure, Dr. Dean says. (If you get general anesthesia, you’ll definitely need that.) Or maybe your child is too young to leave at home, so you need someone to travel with you and look after them.

If a companion is not necessary (or you’re having a medication abortion), then bringing someone is totally up to you, Ragsdale says. Some people want to have an abortion all alone, while other people like having a friend, family member, or loved one by their side.

If you want someone there but can’t find the right person, you might be able to have a volunteer (from PPFA or the NAF, for instance) or abortion doula come with you. (The online resource Radical Doula has a list of volunteer organizations in different states, and some NNAF member organizations provide this service, too.) You can always ask your clinic as well if they know of local options.

8. Plan how you’re paying for it.

The exact cost of an abortion varies widely depending on your clinic, location, type of abortion, gestational age, and insurance situation. A 2014 study published in Women’s Health Issues looked at all known abortion-providing facilities in the United States and found the median cost for a surgical or medication abortion at 10 weeks was about $500. (Then you have to add the cost of factors like transportation and childcare.)

If you have insurance, call them to find out if abortion is covered and in what capacity. Twenty-six states ban abortion coverage on Affordable Care Act Marketplace plans, and some ban abortion on private plans as well, according to the Guttmacher Institute (often with exceptions for life endangerment of the pregnant person, rape, or incest). Medicaid funds generally can’t be used to cover abortion except for in cases of rape, incest, or life endangerment, according to the Guttmacher Institute. This disproportionately impacts women of color, those with low incomes, and other marginalized groups who may need Medicaid for health care.

If you don’t have insurance and cannot afford the cost of an abortion out-of-pocket, you have options. Some clinics will charge less depending on factors like your income, Dr. Dean says. There are also forms of financial assistance available from organizations that work with the NNAF and NAF. “Our counselors will help you access the funds we have and connect you with local funds and organizations, depending on where you are and what’s available,” Ragsdale says. “We can help piece together a package to help get you over the finish line.”

Nicole, whose Kentucky Affordable Care Act plan wouldn’t cover her abortion, was just barely able to scrape together enough money by splitting the cost with her boyfriend. Her best advice when it comes to paying for your abortion? “Don’t wait to make your appointment until you have the money,” Nicole says. “Make the appointment, ask how much it is, and you can figure it out from there.” Ragsdale agrees. “By the time [some people have] dealt with managing to get all those resources together, they’ve passed the [gestational] limit in their state or the next state over,” she says.

9. Make sure you’re able to take care of yourself afterward.

Plan to take it as easy as possible for a few days if you can. Most people will experience side effects like cramping, bleeding, and fatigue after either kind of abortion, Dr. Dean says, and a medication abortion can also cause side effects like chills, fever, nausea, and vomiting, per ACOG.

Stocking up on items like pads, heating pads, and over-the-counter pain relievers can help, Dr. Dean says, as can comfort food, hydrating beverages, and anti-nausea meds or remedies. Here’s more information about exactly what might be helpful when you’re recovering from an abortion, including any unlikely red flags that signal you should call the doctor, such as excess bleeding. Talk to your medical providers about all of this, too.

“I received a concierge level of information from the doctors and nurses about what was going to happen, what to expect, and what to know about something going wrong,” Nicole says. “The doctor, nurses, and staff really handheld me.”

It’s a national disgrace that what is at its core a safe and effective routine health care service became an unnecessarily complicated ordeal due to the logistical barriers that stood in Nicole’s way. “It took so much planning and making appointments and confirming them. All that money and time and driving,” she says. “And it was around the holidays … That stuff piles up.”

Even with the advantages she had—background knowledge of how things worked in her state thanks to her volunteer work, a supportive partner and friends, a car, financial means, and a flexible work schedule—Nicole, like so many, had to jump through far too many hoops to make the right decision for herself and her future.

“It’s really frustrating,” Nicole says. At the thought of these mounting threats to abortion access making things even harder, Nicole sums it up perfectly: “It’s just infuriating.”


9 People With Vaginas on Their Favorite Ways to Orgasm

From eating ice cream cones to packing suitcases, people have interesting tricks for getting things done in their own unique ways. Despite what many cookie-cutter movie scenes may tell us, the same is true when it comes to our sex lives. As a certified sex educator and coach, I’ve found that the list of things people with vulvas enjoy during sex is varied and endless. I’ve also learned that many of these same people have pretty unique tried-and-true ways to orgasm.

But I also hear from a lot of people—especially people with vaginas—who have a hard time orgasming with a partner or even alone. That can be frustrating and isolating, and we don’t talk about it enough. Part of that stigma and struggle might come from thinking you have to orgasm in one certain way, which is totally not the case. There are lots of different things that might be able to make you orgasm—you just have to find what works for you. So, here we talked to people who really have it figured out to learn the one thing that always makes them come. But, remember, if something works for one person and doesn’t work for you, that in no way means you’re broken or weird. It just means you’re not them. Think of this list as some orgasm inspiration or some new tricks to try. And if none of this works for you, just remember that this is showing you a tiny slice of the ways-to-orgasm pie, and it’s perfectly OK if none of this is your jam. And hey, it’s also OK if chasing the elusive orgasm isn’t your thing at all. There are plenty of people who find immense pleasure in sex even if they rarely (or never) orgasm.

FYI, people responded in their own words, so the language below might be considered explicit by some (and is probably considered NSFW by most).

1. Grinding on her knuckles

“My most surefire way to orgasm is the one it all began with: my original masturbation technique when I was a preteen. I lie face down and grind my knuckles into my vulva, moving my legs like I’m making a snow angel. I love the pressure and involving my thighs and quads before I orgasm. Though I can come in different ways, this one is always the fastest.” —Lola J., 30

2. Spanking and spreading

“I almost always come if I’m riding my partner on top and they’re perched up just a bit to kiss me while I massage my clit against their pelvis. And then if they spank me and grab my ass to spread me open while I’m riding them, I’m done. Every damn time.” —Annie J.*, 25

3. Penetration, vibration, and ethical porn

“When I’m with my partner, I experience my strongest orgasms when I’m in doggy style position and have a wand vibrator on my clitoris or vulva. The vibrations supercharge my orgasms. When I’m flying solo, my go-to scenario includes a vibe on my clit and dildo for penetration. Oh, and I do enjoy adding ethical porn into the mix. I get really turned on when I see someone else authentically experiencing pleasure.” —Alicia S., 39

4. Wildly enthusiastic vaginal and anal oral

“When a partner enjoys eating pussy, it is my most favorite thing. They really get in there! I like it when they lick my asshole to my vagina and back, pause right in between, shake their head aggressively, and make some noise, almost like they’re drowning. I feel empowered and dominant during those times.” —Kella M., 29

5. Manual stimulation with guy-focused porn

“When I’m by myself, I usually use one of three techniques. One is just to rub my clitoral hood in counterclockwise circles with my right hand. The other is to do this while putting my left middle and ring fingers inside my vagina, pressing them upward, and keeping them still. (This technique is good if I’m in a rush because that extra hand sends me over the edge quickly!) The last is to put my right middle finger inside my vagina while I rub my clitoral hood back and forth with my thumb. Rarely, I will pull back the hood and touch my clitoris directly and very gently in a sort of up-and-down motion.

I’ll usually do this while watching porn of blowjobs, handjobs, or male masturbation. Even though (or maybe because?) I’m all about women’s sexual empowerment in real life, the partnered scenes that get me off most easily are those that convey a sense of the man’s pleasure being paramount.” —Suzannah W., 28

6. Long, deep thrusts while in doggy style

“I am multi-orgasmic and enjoy getting off in a variety of ways, including having my breasts sucked and using my vibrator. But my absolute deepest orgasms are achieved with repeated long, deep thrusts from a very thick penis in the doggy style position. It rocks every part of me.” —Krys G., 35

7. Fantasizing about submitting to men from everyday life

“I fantasize about taking basic encounters with men I meet way, way further. Sometimes, the seed of one of those fantasies will plant itself in my mind when I’m with them, and I can feel myself start to get wet. As soon as I can manage to get some time alone with my Doxy vibrator, I really grind myself on it, thinking about how much I want to get off for the man in question and just make him feel amazing. I use my fingers to squeeze my nipples and think about submitting to him, giving every bit of myself to him—and then I orgasm as much as I can until I’m exhausted.” —Holly K., 30

8. Putting a vibrator on her nipples

“My nipples are a huge hot spot for me. I can come just from someone playing with them, so I really enjoy my partner licking and sucking them, but nothing gets me off better than a vibrator on my nipples. My partner will turn my Magic Wand up to full blast and gently touch my nipples with it, then pull away. She’s in control, so I just lie there and allow her to do whatever she wants. I orgasm pretty quickly from this. It’s super hot for both of us.” —Jasmine N.*, 29

9. A blindfold and whispers

“When my partner places a blindfold over my eyes, ties my wrists together, and whispers in my ear every way he’s going to use my body, I can orgasm before he even touches me.” —Sunny R., 52

Quotes have been edited and condensed for clarity. All products featured on SELF are independently selected by our editors. If you buy something through our retail links, we may earn an affiliate commission.

*Names have been changed.

Gigi Engle is a certified sex coach, educator, and writer living in Chicago. Follow her on Twitter and Instagram @GigiEngle.


Chronic Hives: Causes, Symptoms, and Treatments


Hives (urticaria) are red, itchy welts that result from a skin reaction. The welts vary in size and appear and fade repeatedly as the reaction runs its course.

The condition is considered chronic hives if the welts appear for more than six weeks and recur frequently over months or years. Often, the cause of chronic hives is not clear.

Chronic hives can be very uncomfortable and interfere with sleep and daily activities. For many people, antihistamines and anti-itch medications provide relief.


Signs and symptoms of chronic hives include:

  • Batches of red or skin-colored welts (wheals), which can appear anywhere on the body
  • Welts that vary in size, change shape, and appear and fade repeatedly as the reaction runs its course
  • Itching, which may be severe
  • Painful swelling (angioedema) of the lips, eyelids, and inside the throat
  • A tendency for signs and symptoms to flare with triggers such as heat, exercise, and stress
  • A tendency for signs and symptoms to persist for more than six weeks and to recur frequently and unpredictably, sometimes for months or years

Short-term (acute) hives appear suddenly and clear up within a few weeks.

When to see a doctor

See your doctor if you have severe hives or hives that continue to appear for several days.

Seek emergency medical care

Chronic hives don’t put you at any sudden risk of a serious allergic reaction (anaphylaxis). If you do experience hives as part of a serious allergic reaction, seek emergency care. Signs and symptoms of anaphylaxis include dizziness, trouble breathing, and swelling of your lips, eyelids, and tongue.


The welts that come with hives arise when certain cells release histamine and other chemicals into your bloodstream.

Doctors often can’t identify the reason for chronic hives or why acute hives sometimes turn into a long-term problem. The skin reaction may be triggered by:

  • Pain medications
  • Insects or parasites
  • Infection
  • Scratching
  • Heat or cold
  • Stress
  • Sunlight
  • Exercise
  • Alcohol or food
  • Pressure on the skin, as from a tight waistband

In some cases, chronic hives may be related to an underlying illness, such as a thyroid disease or, rarely, cancer.


Chronic hives don’t put you at any sudden risk of a serious allergic reaction (anaphylaxis). But if you do experience hives as part of a serious allergic reaction, seek emergency care. Signs and symptoms of anaphylaxis include dizziness, trouble breathing, and swelling of your lips, eyelids, and tongue.


Your doctor will do a physical exam and ask you a number of questions to try to understand what might be causing your signs and symptoms. He or she may also ask you to keep a diary to keep track of:

  • Your activities
  • Any medications, herbal remedies, or supplements you take
  • What you eat and drink
  • Where hives appear and how long it takes a welt to fade
  • Whether your hives come with painful swelling

If your physical exam and medical history suggest your hives are caused by an underlying problem, your doctor may have you undergo testing, such as blood tests or skin tests.


Your doctor will likely recommend you treat your symptoms with home remedies, such as over-the-counter antihistamines. If self-care steps don’t help, talk with your doctor about finding the prescription medication or combination of drugs that works best for you. Usually, an effective treatment can be found.


Taking nondrowsy antihistamine pills daily helps block the symptom-producing release of histamine. They have few side effects. Examples include:

  • Loratadine (Claritin)
  • Fexofenadine (Allegra)
  • Cetirizine (Zyrtec)
  • Desloratadine (Clarinex)

If the nondrowsy antihistamines don’t help you, your doctor may increase the dose or have you try the type that tends to make people drowsy and is taken at bedtime. Examples include hydroxyzine pamoate (Vistaril) and doxepin (Zonalon).

Check with your doctor before taking any of these medications if you are pregnant or breast-feeding, have a chronic medical condition, or are taking other medications.

Other medications

If antihistamines alone don’t relieve your symptoms, other drugs may help. For example:

  • Histamine (H-2) blockers. These medications, also called H-2 receptor antagonists, are injected or taken orally. Examples include cimetidine (Tagamet HB), ranitidine (Zantac), and famotidine (Pepcid).
  • Anti-inflammation medications. Oral corticosteroids, such as prednisone, can help lessen swelling, redness, and itching. These are generally for short-term control of severe hives or angioedema because they can cause serious side effects if taken for a long time.
  • Antidepressants. The tricyclic antidepressant doxepin (Zonalon), used in cream form, can help relieve itching. This drug may cause dizziness and drowsiness.
  • Asthma drugs with antihistamines. Medications that interfere with the action of leukotriene modifiers may be helpful when used with antihistamines. Examples are montelukast (Singulair) and zafirlukast (Accolate).
  • Man-made (monoclonal) antibodies. The drug omalizumab (Xolair) is very effective against a type of difficult-to-treat chronic hives. It’s an injectable medicine that’s usually given once a month.
  • Immune-suppressing drugs. Options include cyclosporine (Gengraf, Neoral, others) and tacrolimus (Astagraft XL, Prograf, Protopic).

Preparing for an appointment

You’ll probably first visit your primary care doctor. He or she may refer you to a doctor who specializes in skin diseases (dermatologist) or to an allergy specialist.

For chronic hives, some basic questions to ask your doctor include:

  • What is likely causing my symptoms?
  • How long will these hives last?
  • What kinds of tests do I need? Do these tests require any special preparation?
  • What treatments are available, and which do you recommend?
  • Do these treatments have any side effects?
  • Do I need prescription medication, or can I use over-the-counter medications to treat the condition?
  • Does the medicine you’re prescribing have a generic version?
  • I have other health problems. Is the treatment you recommend compatible with those conditions?

What to expect from your doctor

Your doctor is likely to ask you questions such as:

  • What symptoms do you have, and when did you first begin experiencing them?
  • Do you have tightness in your chest or throat, nausea, or difficulty breathing?
  • Have you had any viral or bacterial infections recently?
  • What medications, herbal remedies, and supplements do you take?
  • Have you tried any new foods recently?
  • Have you traveled to a new place?
  • Do you have a family history of hives or angioedema?
  • What, if anything, appears to improve or worsen your symptoms?

Lifestyle and home remedies

Chronic hives can go on for months and years. They can interfere with sleep, work, and other activities. The following precautions may help prevent or soothe the recurring skin reactions of chronic hives:

  • Wear loose, light clothing.
  • Avoid scratching or using harsh soaps.
  • Soothe the affected area with a bath, fan, cool cloth, lotion, or anti-itch cream.
  • Keep a diary of when and where hives occur, what you were doing, what you were eating, and so on. This may help you and your doctor identify triggers.
  • Avoid known triggers.
  • Apply sunscreen before going outside.

Updated: 2017-07-06

Publication Date: 2007-06-22