Have you had patients whose allergies to various pollens bring on debilitating dizziness? I have very little congestion, red eyes or the traditional symptoms of allergies, but the dizziness is always worse in spring and fall and is relieved somewhat with over-the-counter nasal sprays and pills.

B

The ear-allergy connection is well known to most ear, nose and throat doctors (ENTs). In fact, I know of one ENT (Jennifer Dereberry, of the House Ear Clinic in Los Angeles) who specializes in this very problem. While most ENTs don't have enough of these patients to build an entire practice, we do have our share of ear-allergy patients.

Some ear-allergy problems are common. Severe nasal allergies can cause eustachian-tube dysfunction, which in turn may cause a variety of ear symptoms, such as recurrent infection, ear pressure, decreased hearing, tinnitus (ringing in the ear) and even vertigo (dizziness). Nasal allergy and food allergy can, on occasion, trigger symptoms reminiscent of Meniere's disease: ear pressure, tinnitus, hearing loss and vertigo.

In her lectures, Dr. Dereberry often tells the story of a man who is allergic to wheat: Whenever he eats wheat, he develops a profound hearing loss which, fortunately, reverses itself after a few days. He tries his best to avoid eating wheat, yet cannot refrain from indulging in an occasional dish of pasta -- with predictable consequences.

My suggestion: Find an ENT allergist and let him or her test you. You may discover that the allergen (the substance you are allergic to) is very avoidable. On the other hand, you may decide that desensitization (getting allergy shots) is worth your while. Desensitization works, although it is time-consuming and bothersome, typically requiring two doctor visits per week for at least six months.

You should also ask your doctor about an over-the-counter nasal spray containing the drug cromolyn sodium. This is great stuff, much better (in my humble opinion) than any other allergy drug. Here's how it works: There are a number of specialized cells in your nose known as mast cells. Each mast cell contains tiny packets (granules) of chemicals which, when released into the nose, cause all of the symptoms we associate with allergy: itching, stuffiness, sneezing, runny nose. When mast cells encounter a particular allergen, they "degranulate" -- in other words, they disgorge their granules into the nasal environment. There are many chemicals locked within these granules; histamine, which is the target of the commonly used allergy drugs called antihistamines, is only one of many of the chemicals released. Cromolyn sodium stabilizes the mast cell to help prevent degranulation in the first place.

Here's a metaphor that I hope will make it all crystal clear. The allergic response (within the nose) is like a barn door flying open, releasing chickens, ducks, cows, horses, goats and sheep into the barnyard. Taking an antihistamine is like rounding up all of the chickens but ignoring the other animals. Cromolyn sodium, on the other hand, bars the barn doors to keep them from flying open in the first place.

This all begs the question: Why on earth do you get dizzy in response to a specific allergen? It's a good thing you didn't ask me this one, because I have no clue why this happens.