Antitumor necrosis factor-α therapy has been used effectively in treatment of many inflammatory diseases such as rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel disease. There are increasing number of paradoxical reactions associated with this therapy that are being reported. We present the case of a 63-year-old male with psoriatic arthritis maintained on adalimumab and methotrexate (previous treatment trials of prednisone and leflunomide) who developed severe symptomatic sarcoidosis in the brain, liver, and lung. Upon discontinuation of adalimumab, the symptoms resolved but the imaging findings persisted. Although the development of sarcoidosis (usually in the lung, skin, and eyes) while on antitumor necrosis factor-α therapy is increasingly reported, the brain and liver are less commonly involved but should be borne in mind by physicians when extensive granulomatous lesions develop.

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There are a number of atopic conditions that involve mast cells ranging from common allergies to arthritis and chronic pelvic pain syndrome. In addition to the well known allergic triggers, many food substances, drugs, as well as physical and mental stressful conditions could trigger mast cell activation in the absence of any allergic diathesis. The chronicity and morbidity of these conditions and the concern for the "adverse side effects" of the available therapeutic agents has prompted the widespread use of complementary and alternative medicines (CAM). One of the most common CAM interventions in the treatment of allergies is the use of dietary supplements that may contain specific compounds such as chondroitin sulfate, bioflavonoids or various herb extracts including Forsythia, Gingko, and Echinacea. The basis of such use has evolved from clinical anecdotal observations over time, to a growing number of in vitro and some in vivo studies that support the use of some of these compounds, especially select flavonoids.