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Food Allergies/mast cell activation follow up

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Question
1. what picture of arthritis do you have.
Anklyospondolysing

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?

My neck has an insane amount of bone spurs resulting in severely reduced range of motion.  My knees are bone on bone

2. Results of your tests. i). How high was your IgE? ESR level? repeated? Did you have a C-reactive protein level?



  Test          Low      Reference Range   Units
vitamin d, 25-hydroxy   29.0         30.0-100.0   


  Test   Low   Normal          High         Ref Range   Units

sedimentation rate-westergren      57   0-40   mm/hr


Test          High          Reference Range
c-reactive protein, quant  6.3          0.0-4.9   


  Test   Low   Normal   High          Range   Units
complement, total (ch50)   >60          22-60   



  Test   Low   Normal   High   Reference Range   Units
antistreptolysin o ab      388.4   0.0-200.0   


ab nk (cd56/16)         408   24-406   /uL
% nk (cd56/16)         20.4   1.4-19.4   %
Test   Low   Normal   High   Reference Range   Units
immunoglobulin e, total         704   0-100   

Anti−DNA(SS)IgG, Ab, Qn 119 High

Did you have skin prick allergy tests?

Yes, three or four times over the past 30 years.  Negative with positive control

patch test- positive for

  Lidocaine
  Propylene Glycol
  Carba Mix
  Balsam of Peru
  Thiuram Mix
  Lyral
  cobalt (II) chloride hexahydrate
  nickel sulfate hexahydrate

) 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.  

I have been on cortiocosteroids over the years. Currently am using sodium chromolyn nebulized medication

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?

My vitamin D had been very low following having 1 liter blood drained from pericardium.  Had been taking high dose vitamin D. Vitamin D is still a bit low but much higher than it had been

CT scan of nose?
Latest sinus ct pretty clear; however thickened tissue-evidence of chronic inflammation  

Chronic inflammation
continued pericarditis-  

just where. It was biopsied to show what kind?
biopsy of pericardium (chronic and acute inflammation)  organizing fibrinous pericarditis.  Constant elevated sed rate and IGG




















































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.

Answer
I apologise it has taken me so long to reply. There has been a glitch somewhere. This response has only just reached me.

Ankylosing spondylitis is a nasty disease, for which you have my sympathy. The exact immunological processes involved are certainly not well understood, but certainly fit a type of auto-immune disease. Your high anti-DNA is entirely compatible with this. People with these can have assorted kinds of "Mixed connective tissue disease" where inflammation affects various non-joint organs, such as the pericardium and the similar coverings of the lung.

Ankylosing spondylosis alone often causes breathlessness due to the inflamed and 'Ankylosing" (- scarred up) of the joints between the ribs and the backbone. Pleural fibrosis (if present") has the same effect on lung movement.

I know of absolutely no evidence that any form of allergic sensitivity is related to AS. Contact hypersensitivity is very common in the general population if you do random tests and often people are not aware of any symptoms related to them i.e. They are not the cause of very long-standing coincidental disease.

I also very much doubt you have asthma or any other king of allergic lung disease. I cannot conceive how cromolyn could help you.

I'd stick with a single rheumatologist familiar with AS.

Hope this helps

Food Allergies

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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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