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Q. I get cold in the morning with pruritic rashes, nasal congestion and eye itchiness. Please help.

Answered by
Dr. Shyam Kalyan. N
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on May 29, 2020

Hello doctor,

I would like to consult for my disturbing allergic flares. I am a 33-year-old female. I am not known hypertensive, diabetic, or asthmatic. Within these three months I have history of morning colds, nasal congestion, pruritic rashes, and eye itchiness. I have no fever, no cough, shortness of breath, headache, and sore throat. I took Monetlukast + Cetirizine once a day and applied Olopatadine optic drops four times a day which did not relieve my symptoms. Therefore, I added Loratadine 10 mg 1 tablet at bedtime. I tried a hypoallergenic diet as well. After two weeks, still, without relief, I added Prednisone 5 mg tablet with a tapering dose for two weeks. There was no significant relief of symptoms. Now, I am still on Montelukast + Cetirizine once tablet once a day, and Loratadine 10 mg one tablet once a day at bedtime. My rashes are getting worse and my sneezing as well. Please help.

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Hello,

Welcome to icliniq.com.

Regarding the treatment, I suggest you continue the medicines as they are. I would like to know how much of Prednisolone did you start with? Nextly, you must start on intranasal steroids to help relieve the nasal symptoms. Use Fluticasone furoate twice daily two puffs in each nostril twice daily. The brands available in the Philippines are Avamys, Flutiair, Nasoflo, Flusort. If you feel the antihistaminics are making you drowsy, then you may keep the Cetirizine for the evening and take Loratidine in the morning.

Apply a mild steroid cream like Betamethasone valerate 0.1% topical cream over the affected skin. The brands available in your country are Diprolene, Diprosone, and Betnovate.

Long term solution: You must do a skin prick testing to check what you are allergic to. Skin prick testing is better than blood allergy testing. Both the methods check for food and aeroallergens. Remember that before the testing you should stop the antihistaminics for five days. With such a test we will come to know the offending agent and give you the right advice to prevent that particular allergen.

Do revert back for more details. Apply mild soap and wear loose-fitting clothes to avoid friction over the affected area on the skin.

Thank you doctor,

That was a comprehensive answer. I am just frustrated with the medications that are not working and new lesions appearing. The pruritus is disturbing. It is affecting my quality of life.

I started on 5 mg tablet, BD for one week then OD. Then I restarted taking Prednisolone 5 mg again today because of the new lesions. The reason why I started with a low dose is because I am afraid that it might compromise my immune system, especially during the pandemic. I am also a doctor and I go on with clinics in my department.

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Hello,

Welcome back to icliniq.com.

I did suspect that you might be a doctor, looking at the way you described your symptoms. Anyway, it will be prudent to get a dermatologist consult also, just to rule out any fungal etiology to your skin problems. The steroid dose you are on is safe and will not increase your susceptibility to the COVID virus. Nevertheless, please take all precautions.


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