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Morris's Sign: Neurogenic Targeting...An Allergist's Observations...

 week ago, I celebrated 60 years of life on this planet...and I began to reflect on 25+ of those years dedicated to studying and treating allergic disease...It continues to amaze me regarding the sheer diversity and variety of allergic manifestations that the human body can manifest.  However, after nearly 3 decades of experience, certain "patterns" seem to show themselves amidst all of this diversity.  I have already reported on what I termed "Eaton's Sign", whereby a patient's site of former skin testing can unexpectedly erupt again, following a cross-reacting allergenic exposure.  Here's another:

Morris's Sign:  An allergic reaction to an inhalant or food may preferentially target a site of prior neurogenic trauma in a patient.  

I have seen multiple examples of this sign over the years:

Case Example 1:  A previously diagnosed food-sensitive patient develops the shingles.  Now, with accidental ingestion of corn, a faint tingling and burning occur in a dermatome distribution site where the patient previously experienced shingles.

Case Example 2:  A patient with prior reflex sympathetic dystrophy accidently ingests milk.  Her right arm flushes and reddens immediately after ingestion.  

 

Case Example 3:  A patient tells me that she always experiences her urticarial eruption first at a small site on her abdomen.  On examination, the spot turns out to be a small scar from a prior laparoscopy procedure.  

 

Case Example 4:  A former food allergy patient returns to see me.  In the interim since I had seen him, he was in an automobile accident, and suffered a seriuous whiplash accident in the neck.  Now, when he accidently ingests his allergen, he not only gets nasal and sinus congestion, but his neck and shoulders ache intensely, just as they first did after the accident.

To my knowledge, this observation has not been commented upon or officially published in medical journals.  And yet allergists like myself see this sign "play out" on regular encounters with our patients, often on a near-daily basis.  Why have the presumption to name it myself?  Well, somebody has to do it.  Why name it Morris's sign?  Easy--Dr. David Morris, a consumate allergist and my mentor in sublingual immunotherapy (SLIT) has just retired after a profoundly productive lifetime of caring for patients.  The tribute is inadequate, but it's one small thing I can do to show my gratitude for all of the knowledge on SLIT he has passed on to me and my colleagues.  

Later, Dude 

 

 

Posted on Monday, April 13, 2009 at 02:19PM by Registered CommenterGeorge F Kroker MD FACAAI | Comments Off

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