10 Things About Sjogren’s That Will Change How You See Your Symptoms

If you have Sjogren’s and a history of allergies, eczema, asthma, or food sensitivities, this article is going to connect some dots for you that no one else has. As a quadruple board-certified allergy/immunology physician who also lives with Sjogren's Disease, it took me years of training and personal experience to understand these connections. But I'm going to explain them to you in the next few minutes, and I promise, some of these will make you say, "Gosh, that explains so much."

The Problem with How Sjogren's is Taught

What frustrates me about how Sjogren's is typically taught in medical schools is that it's presented as a disease of dryness. Dry eyes, dry mouth, maybe some joint pain. Check the antibodies, prescribe artificial tears, and move on. But that’s not the reality for most people living with this disease. The reality is complex, multi-system symptoms that don't neatly fit in a box: unexplained reactions to foods, temperature sensitivity, crushing fatigue, brain fog, burning skin, dizziness. And yet, doctors keep telling you, "That's not Sjogren's. That must be something else." What if it is Sjogren's? What if it’s all connected, and we’ve just been looking at it wrong?

Here are 10 things about Sjogren’s that most people, including many doctors, don't know.

1. Allergies and Autoimmunity Share Root Problems

On the surface, allergies (immune overreactions to harmless things like pollen or peanuts) and autoimmunity (immune system attacks on your own tissues) look different. But they have key things in common: immune system dysregulation and often the same underlying contributing factors, like gut dysbiosis and barrier dysfunction. Think of them as different flavors of the same underlying immune imbalance.

2. Sjogren's Sits at the Crossroads of Allergy and Autoimmunity

I hear it constantly from my Sjogren's patients: "I had terrible eczema as a kid," "I've always had seasonal allergies," "I react to everything—fragrances, chemicals, you name it." These aren't coincidences. These are signs that the immune system has been dysregulated for years, maybe decades, before Sjogren’s was diagnosed. And these conditions don't just coexist; they fuel each other. Mast cells (involved in allergic reactions) can help activate the T and B cells that drive autoimmunity. In turn, chronic autoimmune inflammation can make your mast cells more reactive. It's a vicious cycle that requires addressing the whole immune picture.

3. Sjogren's is Common but Least Recognized

Sjogren's affects an estimated 4 million Americans, making it one of the most common autoimmune diseases, right up there with rheumatoid arthritis. Yet, if you ask the average person—or even many primary care doctors—about it, you'll get a blank stare. And almost nobody recognizes how often it overlaps with allergic conditions. This lack of recognition leads to delays in diagnosis and fragmented care, with patients bouncing between specialists who aren’t connecting the dots.

4. Many with Sjogren's Have Undiagnosed Small Fiber Neuropathy

Do you have burning sensations in your hands or feet? Tingling, electric shock feelings, or extreme temperature sensitivity? Have you noticed changes in how you sweat? Many people with these symptoms are told it’s "just anxiety" or fibromyalgia. But there's often a real, measurable explanation: small fiber neuropathy. This is damage or dysfunction of the tiny nerve fibers in your skin that sense temperature and pain. It's common in Sjogren's (some studies suggest up to 30-40% of patients have it), and while there aren't perfect treatments, interventions like low-dose naltrexone, nerve pain medications, and immune-modulating therapies can help. You can't treat what you don't diagnose!

5. Sjogren's Can Start in the Gut or Oral Microbiome

The majority of your immune system lives in your gut! When your gut microbiome (the community of bacteria in your digestive tract) is disrupted, it can trigger immune activation. The same is true for your oral microbiome. Research increasingly shows that shifts in microbial diversity and mucosal immunity can happen well before the classic symptoms of Sjogren’s appear. This is why I ask every patient about their digestive health—bloating, irregular bowel movements, and food intolerances are all important clues.

6. Antihistamines Can Worsen Dryness

Here's a cruel irony: many Sjogren's patients have allergies or mast cell issues and naturally reach for antihistamines. The problem? Antihistamines, especially older ones like Benadryl, have anticholinergic effects. They block receptors involved in gland secretion, including your salivary and tear glands. So, the very medication you’re taking for allergies can actually make your Sjogren's dryness worse! Newer, longer-acting antihistamines (like loratadine, fexofenadine, and cetirizine) have fewer of these effects, but it’s crucial to be strategic and work with a knowledgeable physician to balance allergy and autoimmune management.

7. Autonomic Dysfunction is Common in Sjogren's (and Rarely Tested)

Your autonomic nervous system controls all the "automatic" functions: heart rate, blood pressure, digestion, temperature regulation. Many Sjogren’s patients have symptoms of autonomic dysfunction—dizziness upon standing, a racing heart, temperature intolerance, sweating issues, or digestive motility problems. Some get diagnosed with POTS (Postural Orthostatic Tachycardia Syndrome), but often, nobody connects it back to Sjogren’s. The connection? Sjogren’s can cause inflammation of the autonomic nerves or antibodies that affect their function. This is testable and treatable!

8. Fatigue in Sjogren's is a Metabolic Problem, Not Just Inflammatory

This isn't normal tiredness; it's a profound, life-altering fatigue. For years, we thought it was purely due to inflammation. While that's part of it, newer research shows that mitochondrial dysfunction—problems with the tiny energy-producing factories inside your cells—plays a major role. Your cells literally can't produce enough energy efficiently. This is why simply treating inflammation isn't always enough. We need to support our body's energy production through targeted supplementation (CoQ10, carnitine, B vitamins), optimizing sleep, strategic movement, and addressing mitochondrial stressors.

9. Early Treatment Can Preserve Gland Function

Sjogren’s is progressive. The longer your immune system attacks your moisture-producing glands, the more irreversible damage can accumulate. Once gland tissue is destroyed and replaced with scar tissue, we're not sure we can get it back. What if we could slow or stop that inflammation before it destroys the glands? This is why early diagnosis and proactive management are vital. A multi-faceted approach, including immune modulators like hydroxychloroquine and lifestyle interventions, can help. And with targeted FDA-approved treatments for Sjogren's on the horizon, the hope is to preserve function even more effectively.

10. Sjogren's Deserves More Awareness and Better Tools

Let's be blunt: Sjogren’s is dramatically under-recognized, undertreated, and underfunded. It affects millions, can impact virtually every organ, and significantly impairs quality of life, yet it's often treated as a minor condition. We need better biomarkers for early detection and for "seronegative" disease. We need more research, a recognition of the full spectrum of its manifestations (especially neurologic), and an integration of care between allergy/immunology, rheumatology, and neurology.

Your Path to Clarity and Confidence

If you're reading this and nodding along, I want you to know: you are not crazy. Your symptoms are real, and they deserve comprehensive, knowledgeable care. This is the exact kind of integrated approach I bring to my practice at the Immune Confident Institute.

If you’re looking for a physician who understands these complex conditions from both sides of the stethoscope, I'd be honored to work with you. You can explore our new patient packages at the link in the description below.

And whether you're ready to work together one-on-one or not, I invite you to our community. Our free Facebook group, Success with Sjogren's, is a place where thousands of people who truly understand this journey come together. The link is in the description—come find your people!

Which of these 10 things surprised you the most? Did any of them finally help you connect the dots on symptoms you've been having? Share your thoughts in the comments below!