It's funny how things can happen in a busy allergy clinic...sometimes you see a confluence of patients that drives a particular clinical point home...Such was the case last week.

Cindy came into my office, delighted that the severe facial eczema she had struggled with for 6 years had gone into remission.  We had found the triggers--dairy and mold--that had precipitated her problem, and treating her had resulted in dramatic improvement.  

"I want to introduce you to a new patient today", she said.  "My sister".  Cindy's sister Joan was the only member of their family who didn't have "traditional" allergy symptoms.  Having 6 siblings, Cindy had related that 4 of them had hayfever, rashes, and "allergies" like she did.  

But Joan was different.  

Joan had arthralgia. No other "traditional" allergy symptoms... And, taking a cue from her sister Cindy, she decided to remove dairy from her diet, and her arthralgias were markedly better.  Simply put, Joan wanted validation that food sensitivity could be related to her joint pain.  

Switch scenes:  That same day, a younger partner of mine, another allergist in the clinic, came in to my office later in the day to consult with me on a curious case he had seen of a lady with springtime hayfever...

...and migratory arthralgias.

As I had blogged about earlier, Warren T. Vaughn had written about palindromic rheumatism related to allergic disease.   Furthermore, D.N. Golding, writing in the Journal of the Royal Society of Medicine, wrote an interesting article entitled "Is there an allergic synovitis?"  In this article he presents 9 patients with episodic allergic rheumatism, related to a variety of precipitating factors--dairy, streptococcal infections, Hayfever, etc.  His conclusion?

It seems that allergy is an occasional cause of episodic rheumatic pain or synovitis in certain atopic patients, whether or not they have an underlying arthritis.  

 In fact, idiopathic eosinophilic synovitis with Charcot-Leyden crystals in joint fluid has been reported by Antes, et. al in the Scan J Rheumatology in 1996 in their article "Idiopathic Eosinophilic Synovitis.  Case Report and Review of the Literature.  

Rheumatic complaints from food sensitivity is not new stuff.  H. Berger, wrote about "Intermittent hydroarthrosis with an allergic basis" in JAMA 112:2402, 1931.  There are others.  

So where does this information put us in 2011? Simply put, allergically-induced rheumatic complaints are an "orphan illness" that no single specialty  is willing to adopt.  Today's allergist has made an a priori decision to limit his/her specialty largely to the respiratory tract, and skin.  Today's rheumatologist is so caught up in autoimmune phenomenon that exogenous triggers are simply overlooked.

And this is a tragedy.  We "dis" joints.  In a word, we're disjointed.  

Allergy should be (and really is) the true Queen of Specialties.  It cuts across multiple organ systems, including the synovial membrane.  To "be all that we can be", to be a Renaissance Allergist, we need to take rheumatic histories on all of our allergy patients.  We might be surprised at what we learn.  

Later, Dude