My new patient, Santa Claus *.

I am presenting this report because of the patient's unique occupational exposures. He is a Workers' Compensation case.

Mr. Claus's chief complaints were sneezing, stuffy head, and some asthma coming almost exclusively on December 24. He had no significant problems the rest of the year, but he lived at the North Pole where there were no contacts with weeds, grasses, trees, molds, or house dust mites. The animals in his area (penguins, reindeer, seals, etc.) are not known allergens.

His troubles begin about December 1 when several things happen. First, his coworkers (the elves) start to prepare toys and other items that Mr. Claus needs for Christmas Eve. This involves woodwork (sawdust and varnish) and preparing teddy bears, dolls, and other gilts. Also, Mrs. Claus polishes their home, moves furniture about, and applies household sprays. Unfortunately, she uses a leather duster that irritates Mr. Claus's sinuses.

About this time, he enters the church for the first time in months. He reads the dusty hymnals and has exposure to incense, scented candles, Christmas trees, and various plants and flowers. Some of the congregants use strong perfumes and others have colds. Fortunately, smoking is forbidden in the church, and it is much too cold at the North Pole for people to stand in the doorway and smoke.

Santa sometimes hits the liquor cabinet. While this may bother his allergies, he is not allergic to eggs (eggnog), corn (bourbon), or barley (scotch). While he is a very happy person (even jolly), he does get irritated by the elves, especially after they have been drinking.

While the increased exposure to the reindeer does not bother him, the hay and straw in the stable make his nose run and he sometimes wheezes. About two days prior to Christmas he takes out his special uniform, a red and white suit that has been stored in mothballs for almost a year. His large, white beard is real so it does not present a problem.

Before going nut on Christmas Eve, Santa has a big dinner. Fortunately, most of the foods rarely cause problems. Turkey, cranberries, sweet potatoes, and the Christmas goose (if in England) are safe, but Santa has to be careful about the turkey stuffing that contains nuts and sometimes oysters. While pumpkin pie is acceptable, he might be wise to avoid mince pie.

On Christmas Eve, Santa hitches the reindeer to his sleigh with the help of the elves, who are always into mischief. He then starts an incredible journey that takes him all over the world in one night! In the Northern Hemisphere in December, he has no exposure to pollens, but when he goes to places like Australia, grasses and trees are in full bloom. He sometimes has problems with presents that he carries in a large, white bag. Once he broke a perfume bottle that was for a lady in Chicago and had terrible sneezing. Another time he carried a cat to a family in Canada and had his worst asthma in years. He also has a strange, irritating habit--he slides down chimneys! This dislodges a large amount of soot that magnifies his problems. It is apparent that this long trip is very tiring for someone of his age, and there should be some consideration to dividing the territory into sections--e.g., having someone else cover the Southern Hemisphere. Somehow Santa manages to stay jolly, even though he does little if any exercise in preparation for this amazing trip.

On physical examination, Santa is considerably overweight, and his cheeks appear quite ruddy. I am worried about his blood pressure and have urged him to lose weight. He claims that this would distort his image, so I suggested that he lose some pounds and then put a pillow under his red suit (obviously not a feather pillow). Often when he visits homes on Christmas Eve, he finds milk and cookies in front of the fireplace; it would be nice if he did not eat them at every home, but he seemed quite stubborn about continuing this practice. He smokes a pipe but states that he is smoking less in recent years. It would be wise for him to stop completely.

In summary, I have presented the case of a man of indeterminate age who works incredibly hard one day a year and is then bothered by his allergies; a burst of steroids might be indicated, starting one or two days before his departure. In the meantime, he should make a concerted effort to lose some weight and try to control his irritation with the

elves; I doubt if this will require antidepressants.

I might add that I do not remember ever meeting anyone with such charisma. He has the delightful habit of saying, "Ho, ho, ho" at every opportunity. MAY HE LIVE FOREVER!!!

Dr. Unger is past president of the American College of Allergy, Asthma, and Immunology.

Reprint requests: Donald L. Unger, MD. 1459 Thousand Oaks Blvd., Thousand Oaks, CA 91360. Phone: [phone].

* Mr. Claus has waived his HIPAA rights to privacy for this report.