Can't stop swallowing due to unknown cause. Nothing has provided relief. (biopsy, doctor)
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
my ENT specialist and allergist believe I may have some sort of sensitivity without necessarily having an allergy. I might try soy or other things in my elimination diet next.
WARNING:The following is a teaching moment some of which some viewers have found disturbing. Look away for those not so inclined and continue for those interested.
I have heard a lot of misuse and conflating all reactions to food as "allergies". Allergies is one of those words have different meaning to different people and so it is often misleading and inappropriate to use the term. Normally the appropriate word that we use is derived from what call the list of hypersensitivity reactions. I won't list them but they are of several different types.
One type of such reaction is mediated by the action of IgE antibodies and those are what we typically call "allergy". They cause immediate hypersensitivity reactions causing the release of histamine. It's the release of histamine that cause symptoms like itchy and runny nose or itchy eyes.
The other reactions especially when it comes to food are intolerances to food or sensitivities might or might not involve antibodies. When they do involve antibodies they are of the IgG type. This is where diet modification is important.
The curious thing about allergies like asthma or allergies to particular foods like shrimp they can do with varying success desensitization vaccines where they put a little bit at a time the that food antigen and then inject it in the hopes of producing IgG antibodies. Those antibodies would clear the antigen and prevent the antigen from binding to the IgE antibody attached to mast cells thus aborting that allergic reaction. That just shows that the two different antibodies cause two different clinical presentations when it comes to disease.
The other reactions especially when it comes to food are intolerances to food or sensitivities might or might not involve antibodies. When they do involve antibodies they are of the IgG type. This is where diet modification is important.
The curious thing about allergies like asthma or allergies to particular foods like shrimp they can do with varying success desensitization vaccines where they put a little bit at a time the that food antigen and then inject it in the hopes of producing IgG antibodies. Those antibodies would clear the antigen and prevent the antigen from binding to the IgE antibody attached to mast cells thus aborting that allergic reaction. That just shows that the two different antibodies cause two different clinical presentations when it comes to disease.
So would I need to know my levels of IgG to determine whether or not I'm prone to food sensitivities or could you explain it more in layman's terms so I can better understand.
And my allergist mentioned/suggested those vaccines since I am most allergic to Cladosporium Herbarum, PENICILLIUM CHRYSOGEN, Aspergillus fumigatus and a few other environmental allergies. Not really familiar with what all these are necessarily apart from being types of mold. I did some online searching and found that Aspergillus fumigatus is found in gluten, corn, other grains, dairy, peanuts, certain nuts, alcohol, fruit and dried fruit. So now I'm curious as to whether I should change my approach to my diet and try avoiding foods that may contain this type of mold rather than strictly dairy and gluten.
So would I need to know my levels of IgG to determine whether or not I'm prone to food sensitivities or could you explain it more in layman's terms so I can better understand.
And my allergist mentioned/suggested those vaccines since I am most allergic to Cladosporium Herbarum, PENICILLIUM CHRYSOGEN, Aspergillus fumigatus and a few other environmental allergies. Not really familiar with what all these are necessarily apart from being types of mold. I did some online searching and found that Aspergillus fumigatus is found in gluten, corn, other grains, dairy, peanuts, certain nuts, alcohol, fruit and dried fruit. So now I'm curious as to whether I should change my approach to my diet and try avoiding foods that may contain this type of mold rather than strictly dairy and gluten.
Any help understanding is appreciated.
It would take hours and hours of lectures to cover the basic and unfortunately redacting or reducing it to simplistic terms would end up in being mislead because simplicity generally eliminates based on probability rather than possibility. In medical slang think of horses and not zebras is a saying that does exactly. I remember and let me restate what happened to me on another board where there was a men in his thirties with large red blood cells and wanted to know what the cause was and I told him it was probably B12 or folate deficiency. The doctor told him he was concerned and I didn't catch that in the proper context. The proper context was the blood smear was probably reviewed and they noted some changes that were abnormal. The next post I saw was that they told him he had pre-leukemia. That really got to me and so I thus became much more conservative and now it's horses and zebras that need to be covered which retains the complicated aspects to it.
There's a lot of problems associated with IgG testing which need to be limited to ones that are most clinically validated such as gliadin and celiac disease. The problem is that most of those are not uniform nor standardized and so most are not very meaningful when trying to connect them clinically. Quite a few are not paid for by insurance companies because they are not validated. If insurance pay for it then I would take them more seriously. They do not by themselves denote an allergy to a food based on the mere presence of antibody. The ultimate standard is the elimination of that food product with resolution of symptoms and returning of symptoms if the food is started again. The classic celiac disease causes pathological changes in the gut as a result of the IgG targeting the gut. The presence of lymphocytes which is the smallest cell in the human body and mostly all nucleus is usually present between gut cells denoting an immune reaction taking place. We often see this in other autoimmune conditions.
"American Academy of Allergy, Asthma & Immunology
View all recommendations from this society
April 4, 2012
Don’t perform unproven diagnostic tests, such as immunoglobulin G(lgG) testing or an indiscriminate battery of immunoglobulin E(lgE) tests, in the evaluation of allergy."
Cautions with regards to IgG ELISA testing specifically when outside the conventional testing,
"In conclusion, food allergy testing by IgG ELISA/EIA panels is a convenient and easy way to diagnose food allergies in a patient. It is, however, a testing method that is questionable in both its theory and validity. It is also costly and may not be reliable, depending on which laboratory you use. An argument in its favor by certain physicians is that it is extremely popular with patients because it gives "printed proof" to the patient that the patient is "allergic" to certain foods. "
It is common to test for environmental molds and there are actually many molds but those are the most common ones that one reacts to. It is the spores that are in the air and if lucky can grow on food. Some molds like Aspergillus fumigatus Aspergillus flavis can grow in the lung especially in those with asthma can be exasperating. Blood serology testing for Aspergillus is also available. Aspergillus flavis is a really bad one if it grows in food (corn peanuts) because it release strong toxins (aflatoxins) capable of causing cancer.
The desensitization shots that compete with IgE reactions are not always 100% effective and so it varies as to how effective they are.
The overall goal is to reduce the antigen load from all sources which are food and environmental. Every bit helps including eliminating some foods and using air filters. One also tries to use mattress covers for dust mites etc. Everything helps in controlling and reducing allergic antigen loads.
For anyone who still cares or is wondering, I am still dealing with the constant swallowing, but have made slight improvements. Started a dairy and gluten free diet on the 28th of April and I recently broke my diet for one day on the 27th of May to reintroduce it into my system to see if it really is the culprit and the swallowing has increased the past couple days so I do feel that it's playing a role in the swallowing, but I'm still not convinced it's the sole reason. I also began taking Zinc supplements about 2-3 weeks ago and it feels as if though I've made the most improvement with the Zinc + gluten/dairy-free diet. When I'm at work, I'll only swallow like every thirty minutes up to an hour and a half, which at that point it's just normal, but when I'm at home the constant swallowing returns, so I am convinced a large part of this is mental since I'm less distracted at home than I am at work, but I will say the Zinc supplements have lessened the compulsive thoughts almost entirely at work. I just wish it did the same at home. I will also say the intensity of the swallowing has also lessened a little bit, which is good.
Still getting an endoscopy done on the 22nd to hopefully rule out any other potential causes since I still feel there is something physically wrong with my throat like an abnormal amount of tightness and sounds my throat makes. Forgot to mention previously that sometimes when I swallow my throat will make a weird croaky/gargling sound as water or saliva travels down my throat. Also, when I get hungry, my lower throat/upper chest area makes a sizzling sound almost like the sound of Pop Rocks candy in your mouth - weird I know.
I guess since I have almost a month out from my endoscopy, I'll hit the reset button and try the diet again to see if it even is worth the effort and money continuing since buying a lot of fresh produce and gluten-free item gets a bit pricey and it's been difficult coming up with new ideas for meals and haven't had too much time to experiment between work and school.
Really hope to return to normalcy at one point in my life again.
I think your method is a bit flawed in that you expect the changes to automatically show results. The body heals at it's own pace, there's no timetable how a diet change will work or do it's magic. It's all based on regularity and length of time your body adjust to the dietary changes.
I've had swallowing, post nasal drip, and sinus infection problems for decades. It disappeared or mostly went away after 9 months on the diet change. It was an added benefit of my weight loss diet. I didn't change my diet to fix this problem.
There are multiple areas that are affected by gluten and lectins. People don't realize how damaging gluten and lectins can be in the long run because it shows up in so many ailments that are being mitigated by pain killers or other chemical remedies but never goes away because the medical industry wants you to stay on their medicines.
Gluten and lectins over time causes autoimmune diseases that start showing up in your skin, which is your first line of symptoms always. Next it affects your nervous system and any achy joints where people think they need to see a chiropractor when in fact you cut out gluten and your tendons and joints slowly regenerate again and not get inflamed much anymore. Gluten and lectin causes a lot of inflammation build up in the body. All the naysayers who keeps eating gluten are some of the people who have achy joints and muscle pain they don't realize and eventually over time and age becomes a degenerative problem.
The next place it attacks is your nose, eyes, ears. You may have people with frequent ear inflections, post nasal drips, swallowing, etc. All misdiagnosed as a severe allergy when in fact they are caused by continuous inflammation caused by gluten and lectins.
Go look up the foods to avoid that are gluten and lectins heavy and eliminate them for a long period of time so your body can slowly heal. It does not disappear over a few weeks or months depending on severity and age.
Why a tennis star who could not volley anymore due to constant pain, switched and cut gluten suddenly got his volley back.
If you have a very leaky gut and constantly inflamed ENT then you need to stay gluten and lectins free for a long period of time to heal the damage done by these plant proteins.
I think your method is a bit flawed in that you expect the changes to automatically show results. The body heals at it's own pace, there's no timetable how a diet change will work or do it's magic. It's all based on regularity and length of time your body adjust to the dietary changes.
I've had swallowing, post nasal drip, and sinus infection problems for decades. It disappeared or mostly went away after 9 months on the diet change. It was an added benefit of my weight loss diet. I didn't change my diet to fix this problem.
There are multiple areas that are affected by gluten and lectins. People don't realize how damaging gluten and lectins can be in the long run because it shows up in so many ailments that are being mitigated by pain killers or other chemical remedies but never goes away because the medical industry wants you to stay on their medicines.
You're right in the fact that I am maybe expecting results too soon. I just thought I would've seen some more improvement in my constant swallowing because I saw great improvement in my weight loss - I lost about 20 lbs. after a month on a dairy/gluten free diet, so I just felt that I should have seen more improvement in that area since I have no sinus issues or anything besides my throat/swallowing, but I'll be more patient. I did see a reduction in acid reflux-like symptoms like way less burping, no upset stomach, my chronic headaches went away and I have also felt the heartburn/acid in my chest go away, but again, little to no improvement in my throat besides the swallowing being less intense.
If it took you that many months to see results, can I ask how you managed to keep going despite maybe not seeing instant results? It's already frustrating enough dealing with this issue that follows me like a dark cloud over my head and adding a restrictive diet on top just makes it a little more stressful, especially when I don't feel immediate results. Since I did consume dairy and gluten a few days ago, I guess it's a good time to change my approach and aim for long-term results. I'll definitely try avoiding lectins, but I'll have to do some more research as to where lectins are found in foods. From what I see currently, it's mostly found in nightshade vegetables, grains, legumes and dairy products. If you have any tips or diet guides they would be greatly appreciated as I feel that avoiding lectins might be tricky to avoid since beans and rice are a large part of my diet now that I've removed gluten and dairy, which was already a HUGE part of my diet. Thanks in advance.
There's a lot of problems associated with IgG testing which need to be limited to ones that are most clinically validated such as gliadin and celiac disease. The problem is that most of those are not uniform nor standardized and so most are not very meaningful when trying to connect them clinically. Quite a few are not paid for by insurance companies because they are not validated. If insurance pay for it then I would take them more seriously. They do not by themselves denote an allergy to a food based on the mere presence of antibody. The ultimate standard is the elimination of that food product with resolution of symptoms and returning of symptoms if the food is started again. The classic celiac disease causes pathological changes in the gut as a result of the IgG targeting the gut. The presence of lymphocytes which is the smallest cell in the human body and mostly all nucleus is usually present between gut cells denoting an immune reaction taking place. We often see this in other autoimmune conditions.
"In conclusion, food allergy testing by IgG ELISA/EIA panels is a convenient and easy way to diagnose food allergies in a patient. It is, however, a testing method that is questionable in both its theory and validity. It is also costly and may not be reliable, depending on which laboratory you use. An argument in its favor by certain physicians is that it is extremely popular with patients because it gives "printed proof" to the patient that the patient is "allergic" to certain foods. "
It is common to test for environmental molds and there are actually many molds but those are the most common ones that one reacts to. It is the spores that are in the air and if lucky can grow on food. Some molds like Aspergillus fumigatus Aspergillus flavis can grow in the lung especially in those with asthma can be exasperating. Blood serology testing for Aspergillus is also available. Aspergillus flavis is a really bad one if it grows in food (corn peanuts) because it release strong toxins (aflatoxins) capable of causing cancer.
The desensitization shots that compete with IgE reactions are not always 100% effective and so it varies as to how effective they are.
Okay thank you for helping me understand you a lot more. Essentially there's no tried and proven method of diagnosing food sensitivities other than doing elimination diets and reintroducing it to the diet to see if there are any changes? If so, I'm wondering what the best process of elimination and how much time is adequate to determine whether a sensitivity is present or not.
It's just all a bit confusing as the allergy test determined I have 0 food allergies, but I have noticed improvement in my acid reflux-like symptoms since giving up dairy and gluten. I occasionally salivate more than normal or burp more than I should, but I think the burping is a result of me constantly swallowing saliva and air. And as far as salivation goes, I tend to salivate more when I'm anxious or I'm thinking about the saliva in my mouth which just leads me to produce more or my throat feels too tight for my saliva to go down on its own so it'll collect in my mouth until I inevitably have to swallow it or spit.
I wanted to ask you about my endoscopy at the end of the month. Let's just say for example my gastro doctor does find swelling/inflammation/redness in my throat, would he be able to determine what the cause of it is? Like does irritation from a food sensitivity look different than irritation from acid reflux/GERD, pharyngitis, allergies, etc. or does it all kind of look the same?
Okay thank you for helping me understand you a lot more. Essentially there's no tried and proven method of diagnosing food sensitivities other than doing elimination diets and reintroducing it to the diet to see if there are any changes? If so, I'm wondering what the best process of elimination and how much time is adequate to determine whether a sensitivity is present or not.
It's just all a bit confusing as the allergy test determined I have 0 food allergies, but I have noticed improvement in my acid reflux-like symptoms since giving up dairy and gluten. I occasionally salivate more than normal or burp more than I should, but I think the burping is a result of me constantly swallowing saliva and air. And as far as salivation goes, I tend to salivate more when I'm anxious or I'm thinking about the saliva in my mouth which just leads me to produce more or my throat feels too tight for my saliva to go down on its own so it'll collect in my mouth until I inevitably have to swallow it or spit.
I wanted to ask you about my endoscopy at the end of the month. Let's just say for example my gastro doctor does find swelling/inflammation/redness in my throat, would he be able to determine what the cause of it is? Like does irritation from a food sensitivity look different than irritation from acid reflux/GERD, pharyngitis, allergies, etc. or does it all kind of look the same?
The gold standard for "allergies" such as those involved with allergic histamine release is reactions to food. You eat a piece of that food and then wait a half hour and see if you breakout in hives or other symptoms associated with histamine release. If it is severe enough with lowered BP and throat swelling then anaphylaxis is the most severe form for such allergic reactions. With other reactions not associated with IgE but associated with IgG then that is more problematic because if they eat a piece of food one doesn't see reactions within a hour hour although in rare situations other causes of food intolerance can be present which isn't antibody induced like Fructose intolerance. It is a biochemical intolerance not cause by antibodies. The IgG antibodies go the gut and target the gut resulting in lymphocyte cells penetrating the gut and causing changes both gross and microscopic that can be seen with biopsy. Not all IgG antibodies cause that type of damage. Some may simply cause distress after a day or two after eating a certain food. It also takes days to recover from the effects. The only definitive way and the gold standard is to withdraw the food and see if symptoms persist or go away.
There are visual clues with endoscopy and in the case of GERD what one looks for is the color change associated with Barrett's esophagus which is a transition from pink to red color. They will do a biopsy to confirm a microscopic change has occurred. The presence of eosinophils in tissue indicates allergies and the presence of lymphocytes indicates chronic inflammation associated with chronic infections and autoimmune disease. The presence of redness and or inflammation may indicate infection with H pylori (they might have change the genus name). They also might find a hiatal hernia which is another thing they look for with acid reflux.
The gold standard for "allergies" such as those involved with allergic histamine release is reactions to food. You eat a piece of that food and then wait a half hour and see if you breakout in hives or other symptoms associated with histamine release. If it is severe enough with lowered BP and throat swelling then anaphylaxis is the most severe form for such allergic reactions. With other reactions not associated with IgE but associated with IgG then that is more problematic because if they eat a piece of food one doesn't see reactions within a hour hour although in rare situations other causes of food intolerance can be present which isn't antibody induced like Fructose intolerance. It is a biochemical intolerance not cause by antibodies. The IgG antibodies go the gut and target the gut resulting in lymphocyte cells penetrating the gut and causing changes both gross and microscopic that can be seen with biopsy. Not all IgG antibodies cause that type of damage. Some may simply cause distress after a day or two after eating a certain food. It also takes days to recover from the effects. The only definitive way and the gold standard is to withdraw the food and see if symptoms persist or go away.
There are visual clues with endoscopy and in the case of GERD what one looks for is the color change associated with Barrett's esophagus which is a transition from pink to red color. They will do a biopsy to confirm a microscopic change has occurred. The presence of eosinophils in tissue indicates allergies and the presence of lymphocytes indicates chronic inflammation associated with chronic infections and autoimmune disease. The presence of redness and or inflammation may indicate infection with H pylori (they might have change the genus name). They also might find a hiatal hernia which is another thing they look for with acid reflux.
Thank you for your response. I had done some mild research regarding Barrett's esophagus and other throat conditions so I know exactly what you're describing. I had done a general blood panel about 3 months ago and my eosinophil levels were normal, but I'm assuming that if I do by chance have EoE, the eosinophil buildup in my tissue wouldn't have shown up on a blood test and would instead need to be confirmed via a biopsy. Or do you think I can pretty much rule EoE out if my blood test showed normal levels of eosinophils?
I'm hopeful that I can get some answers from this endoscopy or at least rule out several causes because it feels that I've been blindly trying different methods/medications to no avail. My gastro doctor did mention though that he'll most likely be doing a dilation along with a biopsy.
Thank you for your response. I had done some mild research regarding Barrett's esophagus and other throat conditions so I know exactly what you're describing. I had done a general blood panel about 3 months ago and my eosinophil levels were normal, but I'm assuming that if I do by chance have EoE, the eosinophil buildup in my tissue wouldn't have shown up on a blood test and would instead need to be confirmed via a biopsy. Or do you think I can pretty much rule EoE out if my blood test showed normal levels of eosinophils?
I'm hopeful that I can get some answers from this endoscopy or at least rule out several causes because it feels that I've been blindly trying different methods/medications to no avail. My gastro doctor did mention though that he'll most likely be doing a dilation along with a biopsy.
Oh and I also got tested for H Pylori twice, once 3 months ago and the other over a year and a half and both times it came back negative.
Thank you for your response. I had done some mild research regarding Barrett's esophagus and other throat conditions so I know exactly what you're describing. I had done a general blood panel about 3 months ago and my eosinophil levels were normal, but I'm assuming that if I do by chance have EoE, the eosinophil buildup in my tissue wouldn't have shown up on a blood test and would instead need to be confirmed via a biopsy. Or do you think I can pretty much rule EoE out if my blood test showed normal levels of eosinophils?
I'm hopeful that I can get some answers from this endoscopy or at least rule out several causes because it feels that I've been blindly trying different methods/medications to no avail. My gastro doctor did mention though that he'll most likely be doing a dilation along with a biopsy.
I can't give you specifics compared to the doctor that has all of the details. I will always defer to the doctor and follow his lead. Endoscopy is good to rule out conditions that need to be ruled out and often a lot of those turn out normal without any significant findings. Obviously the more gross and classic the symptoms are the higher the probability significant findings will show up with endoscopy. With more minor and subtle symptoms the higher the chance they will find nothing. It's obviously easier to diagnose advanced disease compared to the very early stages of disease.
With regards to EoE and eosinophils obviously the presence of eosinophils in the esophagus are a part of the diagnostic criteria. What isn't a part of the diagnostic criteria or mandatory is that the person have blood eosinophilia. The connection between eosinophilia and EoE is that most people with EoE are atopic which means most will have blood eosinophilia. If you don't have eosinophilia then the odds are reduced but not eliminated.
In contrast to hypereosinophilic syndrome (HES) involving the gastrointestinal tract that does require the presence of blood eosinophilia. Obviously allergies as an explanation of eosinophils is much more common than HES.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
