Urologist and Allergist Explore Link Between Allergies and Interstitial Cystitis
Findings point to new treatment options and research directions
“Until now, the evidence linking IC and allergies has been circumstantial,” said
That suggests that there is a correlation between allergies and IC, but can allergies cause bladder symptoms? A clearer answer comes from actual allergy testing and treatment of patients. After holding several discussions on this subject,
These doctors found they were referring patients to each other. Hubbard was sending IC patients with seasonal allergies to Smith, and Smith had allergy patients who also had bladder symptoms. Then, they found that Smith’s allergy testing and treatment was helping to resolve IC symptoms, sometimes dramatically.
Although IC patients’ seasonal allergy miseries are what gave the clue to the connection, Smith is finding that food allergies are common in IC patients. He estimates that 35 to 40 percent of the IC patients he sees have bona fide allergies to foods, based on the results of their skin prick tests and elimination-challenge diets, and that their IC gets better when they remove those foods from their diet. “We’ve been able to identify a lot of food allergies that IC patients didn’t even know they had,” noted
Stimulants, such as coffee and tea, and the acid and spicy foods that have long been known to cause problems for IC patients may be bladder irritants even without allergy. “Put those on already irritated bladder tissue, and you probably are going to see a response,” Smith said. But he’s also finding allergic reactions to some of these items in IC patients. Positive skin prick tests for cayenne (a hot pepper) seem to be common.
The effect on IC of treating environmental allergies with shots or medications is less obvious, said Smith, but still seems to be beneficial. About half to a third of the IC patients he sees have proven environmental allergies or symptoms, such as hay fever, asthma, recurrent ear infections, or chronic urticaria (hives).
Hubbard and Smith are collaborating on a more formal study of the link. One goal is to find a marker that will help urologists decide which patients may benefit from allergy testing and treatment. Like many urologists, Hubbard uses cystoscopy and hydrodistention under anesthesia as part of his workup to exclude other conditions that may cause IC-like symptoms. But he is reviving an older practice of taking a biopsy specimen during the procedure and sending it to a pathologist to look for mast cells because, when mast cells reach a certain density, patients seem to benefit from allergy testing and treatment. Mast cells elsewhere in the body are key players in allergic reactions, but their role in the bladder tissue of IC patients has not been clear.
Dr. Smith and Dr. Hubbard plan to conduct more research and hope to spark the interest of additional IC and allergy researchers. Meanwhile, these doctors are continuing to help IC patients get better. Not everyone responds, said Smith, “But for the high percentage who do improve with allergy management, it’s well worth the effort. It’s one of the most rewarding patient care experiences I have ever had.”
Diet and IC
Future research will reveal more about the role of food allergy in IC patients’ symptoms. Meanwhile, whether patients have “true” allergies or sensitivity to foods, the treatment is the same — an elimination challenge diet. Elimination diets remove the potential problem foods from the patient’s diet and add them back one at a time to see if the food really causes a problem.
ICA offers the following advice to patients when modifying their diets:
- The effect of food and drinks on IC symptoms varies greatly from individual to individual. It’s important to note the type of food or beverage, as well as how much, how often and the specific combination of food and beverages ingested. Give yourself plenty of time to discover your ideal diet. It may require several weeks of trial and error.
- Eat a healthy, varied, balanced diet — most patients can do this if they work to identify problem items first.
To learn more about IC, successful treatment techniques and initiatives to find a cure, visit www.ichelp.org.
About the Interstitial Cystitis Association
The Interstitial Cystitis Association is the only non-profit health association dedicated to improving the quality of healthcare and lives of people living with interstitial cystitis. The ICA provides advocacy, research funding, and education to ensure early diagnosis and optimal care with dignity for people affected by IC.
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SOURCE Interstitial Cystitis Association