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Dear Dr. Kagen,

I am a 43 yr.old female with Graves disease.For the past year,I have been plagued with sinus pain,pressure,vertigo,nausea. Been treated for sinus infection,ear infection,told I had a virus,and the latest,I was told I had allergies. Went for allergy testing,X-rays, and the scratch tests showed I wasn't allergic to anything. I take Claritin,sudafed,Flonase,sometimes Clartin D.

These medicines help my symptoms,but they have their own side effects-one of them being,they interfere with the Synthyroid I take for the Graves disease,and recently I became hypothyroid. When I saw my endrocrinologist for this last week, he said he still thought I was allergic to something and wants me to see another allergist.

What would another allergist do that the first one didn't? Should I just wait it out, and keep taking the Claritin and hope I get better? I do feel better than I did a year ago, but I still feel sick to one degree or another every day. I am getting very discouraged.

Any advice you could give would be greatly appreciated.

Thanks for asking about having allergy like symptoms and negative allergy skin tests.

Many patients have what I refer to as a "wet head". They have excessive mucus, a wet nose, "gunk" down the back of their throats, drainage from their sinuses, dizziness from the fluid which accumulates in their middle ears and frequent infections because of all the mucus.

The question then becomes, "If I don't have allergies, what do I have?"

Two common causes of the "wet head" are 1) acid reflux into the lower esophagus and 2) non-specific hyper reactivity (or hypersensitivity).

Acid reflux can be either obvious or silent. If a patient with excessive mucus has a 'busy stomach' or clear acid regurgitation, a simple test is to take antacids [Zantac at night and Prilosec in the AM]. The sinus, nasal and "gunk" sensation in the throat should end almost altogether after one week of this treatment. If the symptoms do not improve, then one must consider the diagnosis of non-specific total body hypersensitivity.

Sensitive patients often have the following complaints:

  • sneezing and/or sensitive eyes in the sunlight [sunglasses are a MUST];
  • sensitive to alcoholic beverages, easy drunks;
  • an ability to smell things that others can not;
  • sensitive to any change in the humidity or temperature;
  • ticklish from across the room;
  • cold feet at night so that they wear socks to bed;
  • sensitive to any change in their hormone levels to the point that they are able to feel it when they ovulate;
  • a runny nose when entering cool rooms or cold air outside;
  • fatigue and tiredness especially around 2-3:00 PM;
  • sensitivity to all medications, so that pediatric doses of meds often are effective; and finally
  • whenever anything changes inside of or outside of their bodies - they know it and feel it.

These "sensitive" patients can appear to be allergic, where I use the term allergic to mean having allergy immune reactions to allergens like pollens, mold spores, animals or medications. As a matter of fact, the term ALLERGY as originally defined was meant to infer that a patient was hyper-sensitive either by immune or non-immune mechanisms. Today, doctors use the term allergy to mean that a patient has IgE antibodies to something that makes them ill. This is not the correct use of the term ALLERGY.

So, if you need to wear sunglasses and like to put on socks to bed, you may have sensitivity to almost any CHANGE that occurs around you. There is no blood test or skin test to determine this diagnosis. It is a diagnosis based upon clinical judgement and the favorable response to:

  1. Atrovent 0.03% or 0.06% solution sprayed into the nose 3-4 times daily especially 40 minutes BEFORE changing from one environment to another [i.e. going outside];
  2. Sunglasses even on cloudy days to control the amount of light entering the eyes;
  3. Tea [1/3 cup of Lipton bag prepared tea] which for some reason helps to prevent the sensitive patient from having a "wet head" and headaches; and finally
  4. NO light at all for about 4-5 minutes in the mid-afternoon [hold the hands over the yes or actually go into a dark closet] to eliminate the light induced release of serotonin which in turn produces a headache, fatigue and increased appetite.

The above suggestions for sensitive patients originated by my asking my patients, "What works for you?" They are simple to follow and are very effective for most patients with non-allergic "wet heads". Also, and importantly, some patients with no evidence of allergy do improve on intra-nasal steroids such as the Flonase you are taking.

I hope this info is useful to you. Please be certain to discuss these ideas with your doctor. Good luck.

Steve Kagen, M.D