To the Editor.—
The response by Gerald A. Gellin, MD (1981;245:1165), to the question "Dark Circles Around the Eyes," failed to mention the phenomenon of "allergic shiners." This stigmata of allergic rhinitis—dark, often swollen circles below the eyes— is thought to be caused by stasis of blood secondary to pressure on the veins from edema of the mucous membranes of the nasal and paranasal cavities.1-3 Thus, the presence of dark circles around and especially under the eyes should prompt the physician to search carefully for signs and symptoms of allergic disease.
Carlson RE, Hering PJ. Allergic Shiners. JAMA. 1981;246(8):835. doi:10.1001/jama.1981.03320080021014
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