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Q. I have allergic rhinitis and bronchial asthma for the last 15 years. Please guide me.

Answered by
Dr. B Vageesh Padiyar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jul 01, 2021 and last reviewed on: Aug 10, 2021

Hello doctor,

I have allergy issues for the last 15 to 16 years that started from allergic rhinitis and bronchial asthma. Currently, I am on medications for asthma and sacroiliitis. For the previous two months, I was having some issues and flare-ups. I had blood tests today to check whether I was also infected since my parents were COVID positive post their vaccination. I would be grateful if you can please guide me.

#

Hi,

Welcome to icliniq.com.

The most common reason for the symptoms you are having is severe allergic rhinitis with associated sinusitis.

Before we go to the treatment, I will try to explain the cascade of events in a simple manner below, even though it is not as simple as it looks.

Exposure to dust (or any irritative substance that your body is hypersensitive to) will initially initiate reflexes such as sneezing to remove the offending agent out. If this fails, mucosal cells in your nose start to hyperfunction producing loads of mucus to trap dust (owing to its sticky nature). Mucus is blown out of the nose or pushed into the throat by mucociliary activity, thereby entering a new zone. The throat initially reacts by activating cough impulses to push out the mucus. Still, if that fails, a local inflammation around the throat starts, which often leads to symptoms such as a lump in the throat and repeated feeling to clear the throat.

Chronic prolonged inflammation around the nose leads to involvement of the eustachian tubes, which ventilate air and equalize pressure between the nose and the ear. Inflammed lines do not function well, leading to negative pressure in the ear, causing ringing sensations, muffled noise, and sometimes decreased hearing.

Long-standing inflammation in the nose also blocks the sinuses' outflow tract, leading to secretions getting collected, which then get infected and cause a pressure headache around your eyes, forehead, and cheeks. Your glands also get swollen for the same reason.

I know the problem is there for a long time. Still, I am not sure if you have followed any specific treatment chart, which is usually recommended before considering any patient for surgery. This treatment chart is custom-made according to your symptoms and follows the guidelines to treat both allergies and sinusitis.

I suggest the following:

  • Tablet Sinarest (Chlorpheniramine maleate 2 mg, Paracetamol 500 mg, Phenylephrine 10 mg) one tablet twice a day after food 12 hours apart for 15 days.
  • Tablet Allegra M (Fexofenadine 120 mg and Montelukast 10 mg) one tablet twice a day after food 12 hours apart for 15 days.
  • Tablet Zerodol TH 4 mg (Aceclofenac 100 mg and Thiocolchicoside 4 mg)one tablet twice a day after food for five days. (only if there is a headache)
  • Tablet Clarithromycin 500 mg one tablet two times a day after food 12 hours apart for seven days.
  • Donate nasal spray (Fluticasone propionate 50 mcg and Azelastine 140 mcg) two puffs two times a day in both nostrils for three months (do not inhale while you spray the drug).
  • Tablet Mucomix 600 mg (Acetylcysteine 600 mg) one tablet two times a day 12 hours apart after food for one week.
  • Tablet Wysolone 10 mg (Prednisolone) one tablet after breakfast for one week.

1) Wear an N95 mask at all times, do not allow any dust or irritative substance from entering into your nose. It is the most important thing you should be following failing which, no treatment will bring any relief.

2) Steam inhalations three to four times a day.

3) Saltwater gargles 8 to 10 times a day for one month.

4) Do not smoke or consume alcohol as it slows down mucociliary clearance mechanisms.

All precautionary measures have to be followed strictly for maximum relief. Otherwise, medications would not be helpful in the long term.

Surgery can be considered (if the above medications and preventive measures do not give any relief), but there is a catch. The symptoms might come back sometimes, even on a larger scale, after a brief relief following surgery if the preventive measures post-surgery are not followed. So, ideally speaking in a nutshell, I again emphasize preventing any irritative substance from entering the nose and throat, thereby triggering an allergic cascade of events and reproducing the symptoms you have mentioned above.

There is nothing that you need to worry about, once you follow the advice mentioned above, your symptoms should start coming down, and I am sure you will recover with time.

I hope I have answered your query in detail. If there is anything more you need to know or enquire, please do let us know, and we will get back to you as soon as possible.

Warm regards.

Thank you doctor for the wonderful insight.

I have a complex medical history. I had panniculitis post my childbirth before six years, although one doctor said it is tuberculosis of the abdomen. I took anti-tubercular treatment for that though there was no discharge from the tract. For my AS, I am taking tablet Sulfasalazine and tablet Pregabalin for the last two years. I was taking treatment for asthma and was last asked for an X-ray by the treating doctor. I got my X-ray done before three months. Developed cold symptoms three days later and took tablet Macpod CV, tablet Augmentin 625, and tablet Wysolone 10 mg for five days. I have attached the prescription. Again had a bit of discomfort for two days in the next month. I had a bit of runny nose, a bit of pain in the nose, and dryness and body-ache were there and could not differentiate since body ache is also felt in my AS symptoms. My allergy levels are primarily high, up to 800 for the last so many years. Last year, I observed that a single cold episode would make me sick for a month or so. After taking antibiotics and steroids, it settles and again resurfaces in a week or so. For the past eight months, I have taken a short steroid tablet Wysolone 10 mg four to five times. My main problem is allergy. So during this whole COVID time, I have confined myself to home. Last month, I had similar symptoms and took the same medicines since my doctor was not available, and it has been 10 to 15 days now, and I am back to square one. Currently, I am having almost the same symptoms that I had two months back. There is no fever, but a little bit of swelling is felt in the tongue, left eye, and left side of the face.

#

Hi,

Welcome back to icliniq.com.

Thank you for sharing the reports (attachment removed to protect the patient's identity). I did have a look at them in detail. There is a problem of allergy here, as discussed in our previous conversation. Adequate care has to be taken with lifestyle changes and preventive measures as there is no immediate medical or surgical treatment for allergy. Exposure to the triggering factor at home is more than enough to create trouble and cause symptoms that you are having, and there is no hard and fast rule that exposure should only happen outside the house.

Please try to follow instructions as much as possible with all the medications I have suggested.

Do let us know if there are any other queries that you have, and we will revert to you as soon as possible.

Warm regards.


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