How can I manage my chronic runny nose?

Hi,

Welcome to icliniq.com.

I understand your concern.

Allergy and asthma are related to airway hyperreactive disorders. Both conditions involve hypersensitivity reactions and have a genetic basis. For a long time, a permanent cure for allergies remained elusive, but with the advent of immunotherapy, effective treatment is now possible. Immunotherapy is similar to vaccination; it involves administering gradually increasing doses of allergens to the bloodstream to build tolerance over time.

Before starting immunotherapy, we need to identify all the allergens you are sensitive to. The most reliable method for this is a skin prick allergy test. Additionally, blood allergy tests such as ImmunoCAP ISAC (immuno-solid phase allergy chip) and RAST (radioallergosorbent test) offer results nearly as accurate as skin prick testing.

To address your problem, we first need to determine which specific allergens you are sensitive to. Please provide the results of your allergy test so we can identify the relevant allergens. Based on this information, we can recommend immunotherapy, which is the only long-term solution available for your condition.

In the meantime, allergy symptoms can be managed with antihistamines, antileukotrienes, and nasal steroids. For asthma management, bronchodilators, inhalational anticholinergics, and inhalational corticosteroids are often used. Steroids and long-acting bronchodilators can help prevent recurrent asthma attacks and manage nasal allergies.

I have also noted that recently the mucus has developed a foul smell or taste. This, along with sinus congestion and post-nasal drip, suggests a sinus infection. This condition typically requires a course of antibiotics. I would recommend Clarithromycin 250 mg, one tablet taken twice daily on an empty stomach. In addition to the antibiotic, nasal decongestants and systemic medications can help manage the acute infection.

If the sinus infection is only an acute complication of your allergy, it should resolve with antibiotics and supportive care. However, if the infection has been recurring for more than a few months, I would advise a non-contrast CT (computed tomography) scan of the paranasal sinuses. We also perform a nasal endoscopy for patients with such symptoms, which is done as an office procedure.

Allergies can predispose individuals to sinus infections, and sinus infections can exacerbate allergies in those already sensitized. Allergy and sinusitis are interrelated and often act synergistically, leading to greater discomfort than either condition alone.

For managing sinusitis, chronic cases can be assessed through changes observed in a CT scan and relevant alterations in the nasal mucosa noted during endoscopy. A chronic sinus infection can be addressed surgically with functional endoscopic sinus surgery (FESS). While FESS does not cure allergies, it can significantly improve the quality of life for patients with chronic sinusitis. Allergies that persist throughout the day are often related to indoor triggers, and it seems you are already taking appropriate measures to manage this.

Even with meticulous cleaning and dusting, allergens can still be present in the home. In such cases, immunotherapy can be a lifeline. If your allergy is not present continuously throughout the day and year, I recommend keeping a record of when the allergy symptoms are triggered. This may help you identify the specific allergen. Common causes of allergies include molds, pollen, tree pollen, grasses, food, dust mites, and various other particles.

I hope this helps.

Thank you.