Dr. Roach: Longtime allergy issues continue to cause pressure in sinuses

Dear Dr. Roach: What are your thoughts regarding histamine intolerance when eating high-histamine foods? I am a 65-year-old female who has suffered from sinus problems since my late teens. In my mid-20s, I underwent allergy testing. My results revealed that molds, many pollens and dust were my main culprits. No food reactions were noted.

I underwent six years of allergy injections and was prescribed antihistamines — Seldane, followed by Histmanal, until they were taken off the market. Overall, my high volume of mucus production was reduced, along with the number of severe sinus infections. (Environmentally, I have taken many precautions within my home: radiant floor heating, tile and wood floors, no pets, and a clean house.)

What continues is tremendous pressure in my sinus cavities. It is worse after a meal. The pressure can wear me out. (I was puzzled because I eat healthy foods, drink plenty of water, exercise daily, stay on the low end of a healthy BMI calculation and have a nice social community. My regular blood panel results were within the normal range.)

I recently came across information about histamine intolerance when eating high-histamine foods. So many of my “healthy” foods are on the list! Does diamine oxidase (DAO) really help?

— Anon.

Dear Anon.: Although the term “histamine intolerance” is frequently used, there isn’t evidence that there is a deficiency in one of the enzymes that metabolize histamine, such as DAO. Treatment with this has not been proven effective in people with concerns similar to yours.

Since you received benefit from antihistamines, you should try one of the newer antihistamines such as cetirizine (Zyrtec) or fexofenadine (Allegra, which is very similar to Seldane). From my reading, using one of these along with an H2 antihistamine, such as famotidine (Pepcid), has been helpful to some.

Another approach is Cromolyn, taken as a liquid before eating.

Dear Dr. Roach: I have had numbness on the outside of my right thigh for several years. At times, the area would feel like it was on fire, but that pain has since subsided. My doctor ordered an MRI, but doesn’t seem concerned with the fact that this area is numb all the time. I’ve talked to several other people who have similar issues.

I am 62 and in good health. Another person I spoke to is in her 30s and experiences the same thing. Someone else said sublingual vitamin B12 is helpful. Do you have any idea what this could possibly be from and how to treat it? Again, my doctors don’t see it as an area of concern, but it doesn’t seem like something that should be ignored.

— D.M.

Dear D.M.: Numbness and burning are cardinal symptoms of nerve disease. Some people will note a pins-and-needles sensation rather than burning, but this is clearly a neuropathy. The fact that it is so localized suggests the compression of a nerve.

In the case of the outer leg, the nerve supplying that area is called the lateral femoral cutaneous nerve, and when it is compressed, the condition is called “meralgia paresthetica.” It can happen to anyone, but it often happens when a person has changed weight or when pressure’s applied to the area (such as a belt).

90% of cases will get better on their own or by avoiding compression of the area. I have occasionally had to refer my patients to an anesthesiologist for a nerve block. I have had no luck with vitamin B12, but medicines for neuropathic pain, such as gabapentin, can help with pain (but not numbness).

Readers may email questions to ToYourGoodHealth@med.cornell.edu.