Let's talk first, though, about how these patients are going to show up in the ENT office and what kind of presentation an ear, nose, and throat doctor is going to identify in these patients.

So somewhat interestingly, the last Grand Rounds presentation I gave before I left, I previously worked in a department of otolaryngology, was on where this patient could show up in each of the subgroups.

specialty areas in your nose and throat medicine.

So for our rhinologists, these patients will show up with chronic sinus issues that may or may not be related to allergies.

There is an increased prevalence of allergic disease in patients with Sjogren's, but not all of them have that.

You may see drier tissues on exam because that dryness that affects the eyes and the mouth, the nasal mucosa is also there.

For laryngologists, for one thing that's shown up for me and I'm not alone, but, you know, kind of an example is recurrent laryngitis.

Well, that leads me to my next question is, in addition to the serologies, which other labs are most useful as you're approaching these patients and working them up and staging them?

MCAS, mass cell activation syndrome, because two of the past people who've shared their stories on this podcast have had that condition, but we haven't really delved into it from like how to doctor explain what is it? What

causes it? Yeah.

So mast cells are white blood cells or infection fighting cells that are responsible for helping our body determine if we are safe or not safe in our environment.

They do that along with our nervous system, like our sensory nerves, and they are found in the same locations.

So they are working together and there's a lot of crosstalk between these mast cells and our small fiber nerves.

These cells are found in all the places in our body where our body is going to interface with the outside world.

So our barriers, our skin, our respiratory tract, our gut, our genital urinary tract.

system.