Timothy C. Hain, MD • Page last modified: August 20, 2020
Meniere's disease may well be a mixture of several causes that all manifest in a common output pattern -- hearing loss, tinnitus, fullness and vertigo. The requirements for diagnosis, which were defined by a commitee rather than by an objective measurement, are not specific enough to narrow the field down to a single cause. Given this very reasonable idea, why shouldn't allergy be one of the causes ? The purpose of this page is to examine the evidence for and against the idea that allergy either causes or contributes to some cases with Meniere's.
Shambaugh and Wiet discussed food allergy in Meniere's disease as early as 1980.
There are a substantial number of papers that suggest that allergy is more common in Meniere's patients than the general population.
Dereberry (2011) suggested that there are higher rates of allergy in patients with Meniere's compared to other otologic disorders or the general public. Derebery also suggested that allergy might be a "target organ" for allergy. In 2000, Derebery and Berliner reported that the prevalence of allergy was high. " Of 734 respondents with Meniere's disease, 59.2% reported possible airborne allergy, 40.3% had or suspected food allergies, and 37% had had confirmatory skin or in vitro tests for allergy. These prevalence rates were significantly higher than those found in the control group, of which 42.7% reported having or suspecting airborne allergies and 25% had or suspected food allergies". Tyrell et al (2014) reported that persons with Meniere's disease have a 2.2 greater odds of reporting allergy than the general population. Haid et al (1995) reported that "Many of our patients with Meniere's disease suffered from internal diseases (e.g. hypotonia, hyperlipidemia, diabetes mellitus), allergy or an affection of the paranasal sinuses, which may constitute co-factors triggering Meniere's disease. " Keles et al (2004) reported that the prevalence of allergy was higher in patients with Meniere's disease. Sen et al (2005) reported that the prevalence of allergy was higher in Meniere's, and that migraine and MD may be linked by an immunological determinant. Howard (1997) reported that testing for allergy was about twice as positive in patients with "otologic problems". Of course, this could include patients other than meniere's disease. Diberardino and Cesarini reported a a positive gliaden skin test in 56% of their patients with Meniere. They suggested that this may indicate sensitivity to gluten.
There are several opinion papers suggesting that allergy treatment is indicated. Of course, opinion papers are not strong evidence.
Weinreich and Agrawal, (2014) gave their opinion that "the inclusion of allergy control as part of the treatment plan for Meniere's disease is low risk to the patient and should be considered for patients with indications that include history of seasonal or food allergy, childhood or family history of allergy, bilateral Meniere's symptoms, or a development of symptoms within a short time after exposure of food or inhaled allergen."Similarly, Ramakrishnan (2010) opined that "Meniere's disease can improve with treatment of food allergies."
There are a small number of experimental papers involing allergy
- Noell et al (2001) suggested that allergic Meniere's could be diagnosed by detecting an increased ECOG after intranasal challenge.
- Miamura et al (1987) reported that Meniere's like symptoms can be induced in guinea pigs with sensitization followed by antigen challenge.
Overall, the literature is not especially strong regarding allergy and Menieres. This may be due to Meniere's having multiple causes. It would seem reasonable however, to consider treatment of allergy in a Meniere's patient with a strong evidence for allergy.
According to Derebery (2011), at least three mechanisms by which allergy may play a role in the production of fluid in the endolymphatic sac are described: the endolymphatic sac itself might be a "target organ" of mediator released from systemic inhalant or food reactions; deposition of circulating immune complex may produce inflammation and interfere with the sac's filtering capability; and a predisposing viral infection in childhood that produces a mild impairment of endolymphatic sac function may interact with allergies in adulthood and cause the endolymphatic sac to decompensate, resulting in endolymphatic hydrops.
In our view, there is little evidence that the sac provides any filtering capability, but it would seem somewhat reasonable that the endolymphatic sac could be a "target organ", causing it to release cytokines.
Shambough (1984) routinely suggested allergic treatment for Meniere's disease. Dr. Shambaugh was the chairman of otolaryngology at Northwestern Memorial Hospital, which is the hospital that Chicago Dizziness and Hearing is affiliated with. Derebery (2000) reported that allergy treatment, including immunotherapy and elimination of suspected food allergens resulted in improvement. Vertigo control results, by use of the American Academy of Otolaryngology-Head and Neck Surgery classification, categorized 47.9% as class A or B. Hearing was stable or improved in 61.4%. Powers reported that 32% of patients recieving allergy treatment with Meniere's responded to treatment. In some of these patients, metabolic treatment was also used.
Options for allergy treatment include both injections and sublingual drops or tablets.
Overall, considering that doing nothing in Meniere's has quite high success rate (Torok, 1977), lacking a control group, we do not find these treatment studies very convincing. That is not to say that they are useless, but rather that more study is needed.
There is a long history and a modest literature supporting the association of Meniere's disease and Allergy. Our position at Chicago Dizziness and Hearing is that the inclusion of allergy control as part of the treatment plan for Meniere's disease is controversial. We do not routinely recommend allergy treatment in patients with Meniere's. It should mainly be considered for patients with indications that include history of seasonal or food allergy, or development of symptoms within a short time after exposure of food or inhaled allergen.