Curious case of post-nasal drip

DEAR DR. ROACH >>

I am a 70-year-old man in overall good health. I am also a dialysis patient and have neuropathy in my feet. About three or four years ago, I began experiencing very strong nasal dripping during meals, like a running faucet! This happened during every meal every day. Of course, my doctors just brush it off and say, “It’s allergies.” Well, it’s not allergies, and if it were, why does it only happen when I eat a meal?

It doesn’t happen when I have snacks, and it can’t be food allergies — as if, all of a sudden, I’m allergic to every food. Breakfast, lunch and dinner? That’s hard to believe. Any thoughts?

— W.S.

DEAR READER >> You’re quite right; it’s not allergies. It’s a type of nonallergic vasomotor rhinitis, which just means that your nose is getting congested due to the nerves acting on them. Vasomotor rhinitis is physiological. People who have lived in a cold environment know that their noses tend to run for a while after walking around outside, then coming back inside.

One of the major jobs of your nose is to warm up and humidify the cold and dry air, and when you are outside, the blood flow to your nose and the fluid produced both increase to protect your lungs. When you aren’t breathing that cold, dry air, your nose will run like a faucet for a while until the body realizes that you don’t need it anymore.

What you have is a special type of nonallergic vasomotor rhinitis, called gustatory rhinitis. As the name implies, your nose runs when you eat. Different people may have different foods that trigger this response, but hot liquids (like soup) and spicy foods are among the most common. These foods seem to trigger the same nerves that sense the conditions where more blood flow and nasal secretions are needed.

This isn’t an uncommon problem, and I am surprised that your doctors never gave you the right answer. In my research, I did find that this condition might be more common in people on dialysis, although the reason why isn’t clear. In my experience, the most effective treatment for this is avoiding trigger foods if possible, but since you seem to be having symptoms essentially all the time, I would normally prescribe azelastine nasal spray. There are other options available.

I just received my blood test results. What is alkaline phosphatase, and what does a result of 446 IU/L

DEAR DR. ROACH >>

mean?

DEAR READER >> Alkaline phosphatase is a family of enzymes. Most commonly, elevated levels of alkaline phosphatase come from the liver, but it may also be seen in people with bone disease. A level of 446 IU/L is certainly high.

If you had other liver enzymes drawn at the same time, such as gamma-glutamyl transferase (GGT), alanine transaminase (ALT), and aspartate aminotransferase (AST), then elevations of all of them make the liver the more likely cause by far. But if it is only the alkaline-phosphatase level that is elevated, then an evaluation for bone conditions is appropriate. If it still isn’t clear whether the elevated alkaline-phosphatase level is from the bone or liver, an isoenzyme test can sort that out.

Causes of a high alkaline-phosphatase level from the liver include obstructive conditions, like gallstones, and liver diseases, like primary sclerosing cholangitis. An ultrasound is usually the first test. Bone causes of a high alkaline-phosphatase level include Paget’s disease, hyperparathyroidism and hyperthyroidism. Additional blood tests, and sometimes X-rays, are indicated to identify the exact reason.