What can I possibly do to cure my constantly running nose?

Patient's Query

Hi doctor,

I have had a constant runny and congested nose since three years. After years of trying anything possible and seeing several doctors, I was finally diagnosed with a severe dust allergy, as well as asthma by last year. At that time I was pregnant, so I could not be prescribed any medication, but I took extreme measures to help this allergy subside. I have been steam cleaning all rugs at least twice a week, dust every day and everything is hypoallergenic. This has unfortunately done nothing to help. My nose runs constantly, and I mean constantly. I have gone through two rolls of tissue paper in the last 24 hours. I have tried every medication, spray and natural remedy on the market. I have tried three different prescriptions, and nothing has worked. It has affected my job and my home life. The mucus is always clear, watery and lately; it has a foul taste or smell. Doctors in my area have given up on me and said live with it, but I can barely take care of my son because I have to leave all the time to deal with a fountain of mucus coming out of my nose. Please tell me what is wrong with me. What can I possibly do? I am desperate.

Answer

Dr. Shyam Kalyan N

Allergy Specialist Otolaryngology (E.N.T)

Hello,

Welcome to icliniq.com.

Allergy and asthma belong to airway hyper-reactive disorders are inter-related. The two are hypersensitivity reactions and are genetically determined.

A permanent cure for allergy remained evasive for a long time, but now with the advent of immunotherapy, a treatment is possible. Immunotherapy is like vaccination; it releases small increasing doses of allergens into your bloodstream to make the body tolerant to it over time.

Before we do immunotherapy, we determine what all proteins you are allergic to. The most reliable method of doing that is a skin prick allergy test. Blood allergy testing (ImmunoCAP/RAST - radioallergosorbent test) are also available with almost as good results as skin prick testing.

Now coming to your problem, we must first find out what all proteins you are allergic to. For the same, please share the results of your allergy test. Based on the allergens you have been sensitised to we can suggest immunotherapy. Like I said that is the only lasting solution for you.

Temporarily, an allergy can be controlled by antihistamines (Claritin - Loratadine or Fexofenadine and the like), antileukotrienes (Montelukast) and nasal steroids such as Metaspray or Mometasone furoate, Fluticasone, etc.

Asthma would further require bronchodilator medicines (Albuterol or Formoterol or Bambuterol), inhalational anticholinergics (Tiotropium or Ipratropium) and inhalational corticosteroids (Budesonide or Fluticasone). Steroids and long-acting bronchodilators help prevent recurrent attacks of asthma as well as nasal allergy.

I also note that off late the mucus has turned foul smelling or tasting. This along with sinus congestion and post-nasal drip are the signs of sinus infection. This requires a course of antibiotic. Clarithromycin 250 mg one tablet taken twice daily in empty stomach is what I would suggest my patients. In addition to the medicine, some nasal decongestants and systemic medications will help you control the acute infection.

If it is just an acute infection of sinus that is complicating your allergy, then we can ignore the same as it will resolve with a course of antibiotics and supportive medications. However, if it has been recurring for more than a few months, then I would recommend my patients to film a non-contrast CT scan of paranasal sinuses. We also do a nasal endoscopy on our patient with such complaints, and it is an office procedure.

Allergy can predispose to sinus infections, and sinus infection can worsen allergy in an already sensitised individual. Allergy and sinusitis are inter-related and synergistic. The two together cause more suffering than either alone.

Regarding sinusitis management, if the condition is chronic we can understand the same by noting the changes in the CT scan. We also see relevant changes to your nasal mucosa during the endoscopy.

A chronic sinus infection can be managed surgically using functional endoscopic sinus surgery. The FESS surgery (functional endoscopic sinus surgery) in an allergic patient with chronic sinusitis does not cure the allergy but can improve the quality of life significantly.

An allergy that is present perennially throughout the day is mostly due to some indoor items. As you have said, you are already taking enough care regarding this.

In our house, we still might have allergens despite cleaning and dusting everything meticulously. It is in these cases where immunotherapy becomes a lifeline.

If the allergy is not present throughout the day all days a year, I suggest you start noting down whenever the allergy is triggered. This way you may be able to zero on the offending agent. Moulds, pollen, tree pollen, grasses, food, dust mites and a variety of other particles are known causes of allergy.