Dr. Shyam Kalyan. N
Otolaryngology (E.N.T)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I have been suffering from severe sneezing for 24 months. I have been taking Aerius during my pregnancy as it was the safest medicine, but it became worst after the delivery of my baby. I literally cannot stop sneezing. I took Dymista. It was working in the beginning, and then it stopped. I took an Allergodil same thing worked in the first days and then stopped working. My doctor said I have a hypersensitivity type 2, so he gave me Bilaxten and Singulair, and Tonimer Lab hypertonic it also not working. My doctor is suggesting doing laser cauterization in two weeks. I have attached my CT scan and blood test for the EO % and blood count, also my blood test for allergy. I have four air purifiers to control the dust but still not working.
Can you please let me know the answer to my questions below:
1) What is my diagnosis?
2) What should I do as maybe an additional test?
3) What is the immediate treatment to stop sneezing without a steroid, even a nasal one?
4) Is laser cauterization the solution for the non-bleeding nose but water coming from the nose?
5) If laser cauterization is the right solution in my case, can you please explain to me what this procedure is? How long it takes to do it? When to expect the sneezing stop after this procedure? Are there any side effects?
Kindly give your opinion.
Hi,
Welcome to icliniq.com.
It would help if you got the following tests before we decide on any form of treatment, surgery, or medical:
1) Skin prick allergy testing to find out what you are allergic to. If this test is not available, then please do a comprehensive blood allergy profile. Based on the report, we can proceed further.
2) Serum IgE (immunoglobulin).
3) Absolute eosinophil count.
Regarding your CT (computed tomography) and blood reports (attachments removed to protect the patient's identity), they do not warrant the cauterization. We do not do cauterization for allergies. Rarely when allergens are evasive and cannot be found out, we burn the nerve inside using cautery, and that is a treatment for vasomotor rhinitis and not allergic rhinitis. Kindly do the tests I have asked for. I hope this was helpful. Please do revert back to me for further discussion.
Patient's Query
Hi doctor,
Thank you.
I did a blood test allergy and skin test, all negative. The doctor said I do not have an allergy. I have a non-allergic rhinitis hypersensitivity type 2. Also, my eosinophil count is 4.9%. I have attached the blood test report. Kindly give your opinion.
Hi,
Welcome back to ilciniq.com.
The absolute eosinophil count is different from the test you showed (attachments removed to protect the patient's identity). The former is a better indicator of allergy than the plain eosinophil percentage. Nevertheless, it is slightly elevated, signifying some allergies. But no allergy is getting detected. Options are the component-based diagnosis of allergens which is available in certain laboratories, or you could try medical management of allergies for a while. I doubt if the surgical procedure would alleviate your issues. I hope this was helpful.
Patient's Query
Hi doctor,
Thank you.
All I need to know is what exactly I have. Do I have hypersensitivity type 2, or do I have an allergy not yet detected? Because I am taking Blextin as for allergies and it is not working, also as I mentioned in my previous message I took Aerius also is not working, Dymista also is not working, so all medicines for allergy are not working. Is my detailed blood report on allergies visible? Kindly give your opinion.
Hi,
Welcome back to icliniq.com.
I have checked the reports there is no positivity in this. Type 2 hypersensitivity is a cytotoxic reaction, IgG and IgM mediated. They are usually not implicated in reactions like yours. Since probably the doctors are not able to find out any allergy, they are trying to find this angle.
To rule out completely, you need to have a full allergy panel, preferably a skin prick allergy test, not just for the allergens you already tested but for all aeroallergens and food allergens. If that also does not show, we need to go a component resolved diagnosis for allergy, and then we can rule out allergy. I hope this was helpful.
Patient's Query
Thank you doctor,
Please find below diagnostics and let me know. What should I do next? My blood allergy result for house dust mite came back negative. My skin prick test was also negative. Blood allergy tests for foods are also negative. Skin prick tests on these foods are also negative. My doctor told me that you have some intolerance to them but you do not have an allergy to these foods.
Hi,
Welcome back to icliniq.com.
You can try component resolved diagnosis as everything else is coming negative.
Patient's Query
Thank you doctor,
What is component resolved diagnosis? I have done CBC, serology, and IgE. Please let me know what should I take as medicine? What do high eosinophil, SGPT, and SGOT mean?
Hi,
Welcome back to icliniq.com.
SGOT (aspartate transaminase) and SGPT (alanine transaminase) are enzymes that remain deranged in liver diseases. For more consultation on these, I suggest you get in touch with a hepatologist or a general physician. Secondly, when allergies are not picked up by routine tests, we try to do component resolved diagnosis. In this, we check for sensitivity to a particular molecule or component of the allergen rather than the whole allergen extract. This gives us a better picture in cases like yours when a proper diagnosis is not achieved by routine methods. High eosinophils and high IgE (immunoglobulin E) are suggestive of allergy. For high eosinophils, I suggest you take Hetrazan 100 mg (diethylcarbamazine) twice daily for two weeks and then re-do the test.
Patient's Query
Thank you doctor,
Does component resolved diagnosis a blood test or skin test?
Hi,
Welcome back to icliniq.com.
It is a blood test.
Patient's Query
Thank you doctor,
Please send me a prescription to do it.
Hi,
Welcome back to icliniq.com.
I am only allowed to write prescriptions after a video or voice consultation.
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Otolaryngology (E.N.T)
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