The Connection Between Allergies and Ankylosing Spondylitis Symptoms

The relationship between allergies and stiffness symptoms?

Hello, Doctor Gao.
My son is 20 years old and has both ankylosing spondylitis and allergy issues.
He is currently taking four Sulfasalazine tablets daily for ankylosing spondylitis, but he still experiences morning stiffness for about one hour, and his ESR often ranges from 40 to 50 (with CRP around 0.5).
Adding medications like Methotrexate or Secukinumab has not improved his morning stiffness.
His allergy mainly involves allergic rhinitis (he has undergone testing for 36 allergens, but no specific allergens were identified).

Without discussing further treatment options, I would like to know the extent to which my son's allergies might be affecting his ankylosing spondylitis symptoms (morning stiffness and elevated ESR).
Could you advise on which allergy-related tests my son should undergo? I am considering that if these allergy test results are normal or not elevated, I can confidently pursue other treatment options without worrying that allergies are contributing to the difficulty in managing his stiffness symptoms.
Thank you, Doctor.

Zhong, 50~59 year old female. Ask Date: 2023/08/14

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
I believe that allergy symptoms are unrelated to stiffness symptoms.
An elevated ESR may be associated with inadequate control of ankylosing spondylitis.
If you are already taking four Salazopyrin tablets daily and continuously using anti-inflammatory pain medications, yet still experiencing symptoms and having a high ESR, I recommend discussing with your rheumatologist the possibility of applying for targeted therapy.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital, Ministry of Health and Welfare, is concerned about your well-being.

Reply Date: 2023/08/14

More Info

The relationship between allergies and symptoms of ankylosing spondylitis (AS) is a complex one, as both conditions can influence each other in various ways. Ankylosing spondylitis is a type of inflammatory arthritis that primarily affects the spine and can lead to severe, chronic pain and discomfort. It is characterized by inflammation of the vertebrae, which can result in the fusion of the spine over time. On the other hand, allergies, particularly allergic rhinitis, can cause inflammation in the nasal passages and may lead to systemic inflammation, which could potentially exacerbate symptoms of AS.

In your son's case, the presence of morning stiffness (which lasts about an hour) and elevated ESR (erythrocyte sedimentation rate) indicates ongoing inflammation. While it is not uncommon for individuals with AS to experience these symptoms, it is important to consider whether allergies could be contributing to his overall inflammatory state. Allergic reactions can lead to the release of inflammatory mediators, which might aggravate existing inflammatory conditions like AS.

To address your concerns, it is advisable to conduct further allergy-related testing, especially since your son has a history of allergic rhinitis. Although he has undergone testing for 36 allergens without identifying specific triggers, it may be beneficial to consider additional tests or a more comprehensive evaluation. Here are some suggestions for allergy-related assessments:
1. Skin Prick Testing: This can help identify immediate hypersensitivity reactions to common allergens, including pollen, dust mites, pet dander, and mold.

2. Specific IgE Testing: Blood tests that measure the level of specific IgE antibodies to various allergens can provide insight into potential sensitivities that may not have been captured in previous tests.

3. Environmental Assessment: Consider evaluating your son's living environment for potential allergens, such as mold, dust mites, or pet dander, which may not have been previously considered.

4. Food Allergy Testing: If there is any suspicion of food allergies contributing to systemic inflammation, testing for common food allergens may be warranted.

5. Nasal Cytology: This test can help identify eosinophils in the nasal secretions, which are indicative of allergic inflammation.

If these tests return normal results, it may provide reassurance that allergies are not a significant factor in your son's ankylosing spondylitis symptoms. This would allow you to focus on other treatment options for AS without the concern that allergies are complicating his condition.

In terms of treatment for ankylosing spondylitis, it is essential to continue working closely with a rheumatologist. They may consider adjusting his current medication regimen or exploring other therapies, such as physical therapy, biologic agents, or non-steroidal anti-inflammatory drugs (NSAIDs), to better manage his symptoms and improve his quality of life.

In summary, while allergies may not be the primary cause of your son's ankylosing spondylitis symptoms, they could potentially contribute to his inflammatory state. Conducting further allergy testing can help clarify this relationship and guide appropriate treatment strategies. Always consult with healthcare professionals to ensure a comprehensive approach to managing both conditions effectively.

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