Do Allergies Affect Symptoms of Ankylosing Spondylitis?

Can allergies affect the symptoms of stiffness?

Hello Dr.
Tseng, my son is 20 years old and has both ankylosing spondylitis and allergy issues.
He is currently taking two tablets of Celebrex daily for ankylosing spondylitis, but he still experiences morning stiffness for about an hour and his ESR often rises to 40-50 (with CRP around 0.5).
Additionally, taking medications like Voltaren or Humira has not improved the morning stiffness.
His allergy issue mainly involves allergic rhinitis (he has been tested for 36 allergens without any identified triggers).
Without discussing further treatment options, I would like to know the extent to which his 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 think if these allergy test results are normal or not elevated, I can confidently pursue other treatment options without worrying that allergies are contributing to his stiffness symptoms.) Thank you, doctor.

Zheng, 50~59 year old female. Ask Date: 2023/08/15

Dr. Zeng Guosen reply Internal Medicine

If a person has severe allergies that lead to irregular daily routines, it may affect the stability of autoimmune diseases.
Mild symptoms typically do not have such an impact.
Based on your description (morning stiffness lasting about 1 hour and an ESR frequently elevated to 40-50, with CRP around 0.5), it appears that your ankylosing spondylitis is not yet stable.
You can consider other treatment options for better management without suspecting that allergies are causing the stiffness symptoms to be difficult to improve.
However, if allergic rhinitis remains unstable, it is advisable to consult an otolaryngologist for proper management.
Thank you for your question.

Reply Date: 2023/08/15

More Info

Allergies can indeed have an impact on the symptoms of Ankylosing Spondylitis (AS), although the relationship may not be direct. Ankylosing Spondylitis is a type of inflammatory arthritis that primarily affects the spine and can lead to severe, chronic pain and discomfort. The condition is characterized by inflammation of the spinal joints, which can result in stiffness and pain, particularly in the morning or after periods of inactivity.

In your son's case, he is experiencing morning stiffness and elevated ESR (Erythrocyte Sedimentation Rate), which indicates inflammation in the body. While allergies, such as allergic rhinitis, may not directly cause the inflammatory processes associated with AS, they can contribute to overall discomfort and may exacerbate symptoms indirectly. For instance, if your son is experiencing significant allergic symptoms, such as nasal congestion or sinus pressure, this could lead to increased discomfort and a perception of worsening pain or stiffness in his joints.

Moreover, chronic inflammation from allergies can potentially influence the immune system, which may have implications for autoimmune conditions like AS. It is also worth noting that individuals with AS may have a higher prevalence of other autoimmune conditions, which could include allergic responses.

To address your concerns about the potential impact of allergies on your son's AS symptoms, it would be beneficial to conduct a thorough evaluation of his allergic conditions. Since he has already undergone testing for various allergens without identifying specific triggers, it may be worthwhile to consider additional assessments. These could include:
1. Skin Prick Testing: This test can help identify immediate allergic reactions to specific allergens, such as pollen, dust mites, or pet dander.

2. Specific IgE Testing: Blood tests that measure the immune system's response to specific allergens can provide insight into potential sensitivities.

3. Environmental Assessment: Evaluating the home and work environment for potential allergens, such as mold, pet dander, or dust, can help identify triggers that may not have been considered.

4. Nasal Endoscopy: If nasal symptoms are significant, a referral to an ENT specialist for a nasal endoscopy may help assess for structural issues or chronic sinusitis that could be contributing to his symptoms.

5. Monitoring Symptoms: Keeping a detailed diary of symptoms, including any correlation between allergic reactions and AS flare-ups, can provide valuable information for managing both conditions.

In terms of treatment, managing allergies effectively may help improve your son's overall quality of life and potentially alleviate some of the discomfort associated with AS. This could involve the use of antihistamines, nasal corticosteroids, or other allergy medications as prescribed by a healthcare provider.

In conclusion, while allergies may not be the primary cause of your son's AS symptoms, they can certainly play a role in his overall health and comfort. By addressing his allergic conditions through appropriate testing and management, you may find that his AS symptoms become more manageable. It is essential to work closely with his healthcare team to develop a comprehensive treatment plan that considers both his AS and allergy issues.

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