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Food Allergies/allergies and mast cell activation

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Question
QUESTION: Could multiple contact allergies dx through patch test (chronic itching and intermittent rashes ) trigger a mast cell activation with long standing sinus inflammation, pericarditis and arthritis?

ANSWER: The simple answer is no. I can give reasons why if you wish, but it's rather involved.

I presume you have had investigations regarding your joint and pericardial problems. If you have not then you should.

If you wish to get back to me, I would need the results of previous investigations.



---------- FOLLOW-UP ----------

QUESTION: I have had a longstanding history of arthritis, frequent sinus infections/bronchitis/reactive airway disease.  From November 2012 through July 2013, I had chronic sinus inflammation(ct of sinus), frequent bronchitis/reactive airway. Peak flow tests placed me at 65-85% lung function.  I am not a smoker.  After 5 months, my local ENT  referred me to an ENT at a major hospital in NYC.  Blood work showed elevated sed rate, IGE and several other markers of inflammation.  The ENT from NY ordered another CT which showed evidence of chronic inflammation. The ENT looked at the blood work and felt that there was an underlying autoimmune or inflammatory process.  I was sent to an infectious disease doctor, rheumatologist and an immunologist (specifically recommended) The ID doctor and rheumatologist both felt that there was an underlying systemic inflammatory response but couldn't pin it down.  I have been allergy tested(scratch and blood test)4 or 5 times over the past 50+ years.  The most recent allergy testing was done three years ago by an allergist who is on the national board for testing.  Tests have always been negative despite chronic post nasal drip since I was 7 or 8 and a history of sinus problems and reactive airways which NEVER responded to inhalers/nebulizers. The immunologist suspected connective tissue/mast cell activation.  My first appointment, with the immunologist, I had sinus stuff going on and was getting more and more winded. My lung function was only 60 and the immunologist was debating hospitalizing me. She treated me for reactive airways.  I called her a few days later informing her that I would get winded just sitting and talking to someone.  Walking more than 1/2 block was almost impossible.  The immunologist ordered a CT of the chest. I had the CT done on my lunch break and never made it back to work.  I was sent right to a cardiologist who did an echo which confirmed that I had a large pericardial effusion.  I was admitted to the hospital that evening and a liter of blood was drained the following morning.  Four days later, I went back to the hospital for an outpatient MRI due to increasing symptoms.  The fluid was returning and the upper right chamber was collapsing.  I was wheeled to the telemetry unit and transferred to a hospital where a pericardial window was performed.  I was feeling pretty crummy until two months ago (4 months after the window#. I continued to have sinus problems and developed tachycardia and increased blood pressure after the effusion.  Three months ago, an MRI of the heart revealed continued pericarditis of unknown origin.  The biopsy of the pericardium showed both chronic and acute inflammation.  

The immunologist is convinced that I have mast cell activation/connective tissue involvement.  She had done research into T cell mediated conditions at a major hospital for several years before returning to private practice 10 years ago.  

A few weeks ago, I went to my dermatologist for a routine skin check.  She noticed that my back was all scratched up.  I told her that I am always itchy.  Patch testing #80 substances) was done three weeks ago.  It turned out that I had a strong reaction to two substances, moderate reaction to one substance and  borderline reaction to several substances.  I was given a 60 page data base with products that I can use. I am now using specific soap, detergents, shampoo, moisturizers etc
and following a low histamine diet.  I am taking several medications to control the sinus inflammation, airway symptoms, tachycardia and pericarditis.

Are the contact allergies and multi system inflammation two separate conditions?  I am not thrilled about being on so many different medications!!!!!!!!

Answer
Thanks for your reply, your long answer raises more questions than answers.

1. what picture of arthritis do you have. Does it have the typical picture of rheumatoid? Usually, that is obvious to any clinician. Age of onset? Progress with time. Are your fingers affected and if so, in which joints?
2. Results of your tests. i). How high was your IgE? ESR level? repeated? Did you have a C-reactive protein level? Did you have skin prick allergy tests? If so and were they negative? was the positive control negative? ii)I presume you had rheumatoid and anti-nuclear factors done. Protein electrophoresis? Results? iii)To what did you react on contact testing? iv)Percentage results on lung function tests are pretty meaningless. Actual values measured how? And of which tests? v) You say you have had no beneficial response to nebulisers/ bronchodilators, did you not have a trial of corticosteroids? You cannot assess bronchial responsiveness without. vi) the commonest causes of itching without a rash present are low serum iron  and some kinds of liver disease. I presume those were done? Is there any protein in your urine?

My prejudice is that you do have a connective tissue disease, except lung and nose involvement is very odd. CT scan of nose? Chronic inflammation just where. It was biopsied to show what kind? Eosinophils and/or mast cell numbers in the biopsy?

You say you are on multiple medications, what? Do you ever take aspirin or other Non-steroidal anti-inflammatories?

Sorry to be long-winded, but your case seems unusual. Could it be due to more than one condition? Yes, but in general, one could say that a single diagnosis which explains everything is statistically as likely.

I'll have a good think once your answers have been considered properly.

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David Pearson

Expertise

Any in the field I believe. Only experience of questions that get asked will tell.

Experience

I am a retired medical academic from the UK. I have done major research on Food Allergy and have been a government adviser in the area. 30 years experience running an allergy clinic. And undergraduate and post-graduate teaching.

Organizations
Well, apart from the FRCP, I'm no longer active in the area. I'm too busy writing books. And I no longer have the cash to go to international meetings. But was active in many.

Publications
Will 120 scientific papers help? Chapters in books. Patient advisory materials. Magazine articles. TV appearances. Live and recorded. National and international invited lectures, etc. It was my job for 40 years. Do you think I count!

Education/Credentials
MD, PhD, Postgraduate Diplomas etc. Fellow of the Royal College of Physicians. etc. But I don't want that put out on the net! Just to let you know!

Awards and Honors
irrelevant.

Past/Present Clients
Too many to count, patients of course and a large number of all sorts of corporate consultancies and considerable work as an expert witness in the Courts. I'm volunteering because your Greek expert has been so helpful, I thought I'd offer something back.

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