Dear Dr. Roach: I am an 85-year-old female who has had primary biliary cirrhosis of the liver for many years. I have been on 300 mg of ursodiol taken three times a day for all those years, with no problems until now. I currently have severe itching all over my body. I am now taking 4 g of cholestyramine a day to relieve this terrible itching, but after two weeks, I am not feeling any relief. Will this medication work? If so, how long before it does? — B.N.

Answer: Primary biliary cholangitis (many still refer to it by its former name, primary biliary cirrhosis, even though many people never get cirrhosis) is an autoimmune disease, where the body attacks the bile ducts, leading to cholestasis (the lack of movement of bile).

It is a rare disease, much more common in women and usually diagnosed in middle age. It can be found by screening labs or with symptoms of fatigue, jaundice or itching.

Ursodeoxycholine (Ursodiol), first identified in bears, has been the mainstay of treatment with PBC and has improved the prognosis of this condition. It is used to slow progression of the disease and prevent the need for liver transplantation by preventing cirrhosis.

Ursodeoxycholine by itself may not treat itching particularly well, and nearly 80% of people with PBC will develop itching by 10 years of having the condition. Most people do well with the cholestyramine you were given, although the dose necessary is sometimes a lot higher. The dose is usually increased over weeks, so when you go back to your liver specialist, they may increase the dose. Be sure not to take ursodeoxycholine near the time you take the cholestyramine.

There are other options, including rifampin and naltrexone, if the cholestyramine does not work for you. Also, the itching in PBC sometimes comes and goes for no apparent reason.

Dear Dr. Roach: I am a 76-year-old female and have had alopecia since I was 5. I also take Synthroid. When I was receiving one of my COVID shots, I was asked if I had an autoimmune disease. I said I didn’t have the faintest idea. Later, I heard that alopecia was an autoimmune disease, instead of the usual saying, “No hair, no reason, no cure.” My questions are: How do I know if it is? And why was it important to know for the shot? — L.J.K.

Answer: Alopecia is a general term for hair loss, and several kinds of alopecia are thought to be autoimmune in nature, with the body’s immune system attacking the cells that grow hair. Most cases of thyroid disease are autoimmune as well. People with one autoimmune disease are at a higher risk for others.

The COVID vaccine may be less effective in some people with autoimmune diseases when they are taking medicines to suppress the immune system. Further, when vaccines were in short supply, those with immune system diseases were at a higher priority to get the vaccine. Now, however, there is no reason for you to take the COVID vaccine differently from anyone