"I Can't Breathe Through My Nose and I Want My Ten Dollars"

By Allan D. Lieberman, M.D.

As soon as I entered the room to see my new patient, it was clear from his voice that he could not breathe through his nose—at all. He was completely obstructed, which made everyone around him uncomfortable as he was having such difficulty breathing.

A careful history beginning with his birth and continuing to the present (at that time) revealed some early signs of his being allergic, but no other significant problems. His nose had been stopped up continuously for several years and there was no apparent seasonal component. He was new to the southeast, having come from New York where he was the manager of a successful restaurant. Occupationally, his exposures had always been basically to food and people. He was sent to our city of Charleston, South Carolina, to open a new restaurant.

It was obvious to the medical staff at our Center that he had an environmentally triggered upper airway problem, but to what was he reacting? Whatever it was, it was something he was continually being exposed to. Allergic rhinitis (allergy of the nose) is one of the most common complaints seen in an allergy practice. The allergens or triggers are usually airborne—dust, mold, danders, and, if seasonal, pollens. But I suspected this patient’s trigger was food, so I asked him if he would be willing to do a specific elimination diet for four days. This, I thought, would be sufficient time for him to clear his signs and symptoms and then he could begin to re-challenge each food separately, just four foods per day. He agreed, and I was so certain that his nose would open by the fourth day, I bet him ten dollars on the event!

Four days later, he called the office and demanded to speak with me. When I got on the phone, all I could hear was, "I want my ten dollars." I quickly recognized from his voice that he was the patient from earlier in the week with the completely stopped up nose. I asked him if he wouldn't mind waiting just another two hours as it wasn't yet quite long enough, and if his nose didn't open I would pay him the ten dollars. He agreed and hung up the phone.

I was in my office with another patient when there was a knock on the door. In came this same gentleman who stuck out his hand and said, "I want my ten bucks." He was obviously still stopped up, so I had lost my bet. I paid him the ten dollars and he left the room.

Several months later, on a Saturday afternoon, I was surprised to receive a call from a woman inviting me and my wife to be guests at the opening of this same gentleman’s new restaurant. I thanked her but explained that we had a house full of visiting family so we could not accept the patient’s kind offer. A few minutes later she called back and said the manager would like you to bring your whole family to dinner, so all eleven of us when to dinner at the new restaurant.

It was quite a feast, with at least eight courses served, and finished with a stunning flaming dessert. I had not seen my patient, the manager, the whole night. As I stood up to leave the table, I felt a hard whack across my backside and turned around to see my patient, the manager, smiling broadly.

"I think you got your ten buck's worth," he said, in a perfectly clear voice, with not a trace of stopped up nose.

He then went on to explain that I was right. He had continued as I had instructed for one more day after he left my office with the ten dollars, and when he awoke on the morning of the fifth day, his nose was open and stayed open until he challenged back wheat. The culprit was the food he craved the most and ate the most, as he loved to sample his restaurant’s fresh-baked wheat bread!

A humorous story? Yes, but a very common one that teaches us the fundamentals of food allergy, as will be explained in our article, Allergy—The Number One Environmental Disease.