THE ALLERGY – MÉNIÈRE’S DISEASE CONNECTION

 

For the more than 600,000 people in the U.S. who suffer from Ménière’s disease (“MD”), recurring bouts of vertigo and other forms of dizziness can be some of the most uncomfortable and debilitating symptoms of the illness.  In seeking relief from the dizziness, it is important to consider how allergies can play a role both in the manifestation of MD and how the disease is treated.

 

According to the House Clinic’s M. Jennifer Derebery, M.D., the suggestion that allergy might play a role in dizziness and Ménière’s disease was first published back in 1898.  “Today, we officially say that we do not know the cause of MD; in other words, it is idiopathic,” she said.  “However, in virtually any text book or chapter on MD, the list of possible causative or contributing factors will include allergy. 

 

“In our own practice, in a very large survey with several hundred MD patients, we found that 40 percent of them had been diagnosed by a physician with a blood and/or skin test with allergies.  The ‘usual’ rate of allergic rhinitis quoted in the United States is 20 percent.”

 

On the treatment front, when it comes to MD, allergy treatments are widely used to help relieve symptoms.  “Today most of the medications that we physicians use to treat vertigo (spinning dizziness) are antihistamines,” Derebery said.  While originally developed to treat the symptoms of allergy, most Ménière’s patients today are prescribed antihistamines, such as Meclizine (ANTIVERT^®), Dyphenhydramine (BENADRYL^®) or Dramamine. 

 

Derebery points out that the above medications are felt to work to suppress the symptoms of vertigo by blocking certain chemical pathways in the level of the brain.  “Additionally, antihistamines likely help to suppress vertigo by blocking some of the effects of the allergic mediator histamine, as well,” she said.  Histamine, a chemical known to produce the common symptoms of allergy, including itching,  sneezing, nasal congestion and runny nose also greatly excites or increases electrical activity of the semicircular canals (balance organs.)

 

But not all antihistamines prescribed for the treatment of allergy of the nose (allergic rhinitis) are effective in suppressing vertigo associated with Ménière’s disease. That is the case for antihistamines that do not cause sedation.  “They do not cause sedation because they do not cross into the brain; in other words they do not cross the blood brain barrier,” says Derebery.  “Therefore, these antihistamines cannot sufficiently penetrate into the inner ear or into the balance centers of the brain to be helpful.  Despite that, it is surprising how often these are prescribed as the ‘treatment’ for patients with Ménière’s disease exaggerated by allergy.” 

 

So, what is the most consistent treatment that will help patients with Ménière’s disease and allergy get improvement?  “The most consistent treatment, in my experience, is very specific therapy given by either a dietary elimination of diagnosed food allergies or allergy immunotherapy (allergy shots for inhaled allergens),” said Derebery. 

 

“Allergy immunotherapy is commonly misunderstood.  It is actually a vaccination therapy, whereby extracts of the inhaled allergens that a patient has been found to be allergic to are injected into the body.  This causes the body to make protective antibodies to help block both the effects and lessen the reaction in the future when they are exposed to the same allergens.”

What benefits can MD patients expect from allergy treatments? “When patients get best relief, the MD symptoms are an essence in remission,” said Derebery.  “We have our best results with vertigo control.  The vast majority of our patients treated with allergy immunotherapy and/or food allergies have either a reduction, or in some cases, a cessation of their vertigo symptoms.  “

 

Sometimes the benefits can extend to helping with the hearing loss aspects of Ménière’s.  Derebery points out that in the early phases, when there is still a lot of activity (fluctuation) going on with MD, allergy therapy or other effective forms of therapy may help stabilize hearing and either improve or prevent it from getting worse.  “But at a certain point, when hearing loss with MD has gotten bad enough, I do not know of anything that will improve it,” said Derebery.  “I  hope that one day our own results on hearing improvement with MD on allergy treatment will be better.  We typically are more likely to see stabilization of hearing than actual improvement back to normal levels.  Perhaps if we were more likely to ‘capture’ these patients earlier in their disease course it would be helpful.  Hearing improvement in patients with MD, in addition to the vertigo we can usually control now with medication or surgery, is the next big area of research for the future.

 

“As an added and expected benefit, the vast majority of our patients with allergy and MD currently on  therapy for the MD get a significant improvement in their nasal congestion, sneezing, runny nose, and eye symptoms.”

 

Many MD patients with allergies find allergy treatments helpful. In fact, according to results of a study published in 2007 by Current Medicine Group LLC, Dr. Derebery reports that out of 113 MD patients treated for symptoms of allergy with desensitization and diet, all 113 showed a significant improvement after treatment, both in allergy symptoms and MD symptoms. The patient ratings of frequency, severity, and interference with everyday activities of their MD symptoms also appeared better after allergy treatment than ratings from a control group of untreated patients.

 

What lies ahead for the use of allergy medications as part of overall course of treatment for Ménière’s disease? 

 

“There are clinical trials going on right now with the use of sublingual (under the tongue) immunotherapy specifically for nasal allergies and asthma,” reports Derebery.  “These drops and/or tablets are typically only one allergen and are given without any additional allergy injection therapy.  The results from Europe, where this is widely used now, indicate this treatment is very safe, effective, but not as effective as allergy injection therapy.  It is also not clear if the results last as long.  Nonetheless, this might be an interesting form of therapy when it has been approved by the FDA for the treatment of nasal allergies, to use for a trial in patients with allergic dizziness and/or patients with MD who also have allergy.

 

“We will be embarking on a clinical trial in the very near future on MD whereby patients are given either a steroid or placebo in the form of a gel injected into the middle ear.  Steroids can very effectively (at least temporarily) lessen the symptoms of allergy, whether it is involving the inner ear, nose, or lungs.  This depot preparation appears to give its effects for about 2-3 weeks.  We frequently use injectable steroids now to ‘calm down’ the inner ear of a patient with poorly controlled MD.  The idea is to see whether or not this depot preparation will give a better and longer lasting result.” 

 

Dr. Derebery encourages anyone who has MD and would like to consider participation in the upcoming trial to contact Maria Vargas, AuD. at the House Ear Institute for information.