I am a 20-year-old male suffering from a sneezing problem for the last 3-4 years. My height is 172 cm and I am 58 kg weight. Daily I am sneezing in the morning and following that if I do not take medicine then I will get a high fever and cold along with it. The sneeze is only temporarily relieved with medication but recurs when I stop the medicine. I had breathing problems in the past. The doctor said that in my blood, the eosinophil cell count is more. What should I do?
Welcome to icliniq.com.
I have looked through your reports (attachment removed to protect patient identity). Also, I wish to know the following details to make a more decisive diagnosis.
1. Regarding breathing problems and eosinophilia, what was the breathing trouble you had in the past?
2. What medicine did your doctor prescribe for you? If you have any reports or prescriptions or tests kindly attach those in the next query.
3. How many times do you sneeze per day? Do you smoke or drink?
4. Are you working? If so what are the atmospheric conditions at your workplace? Do you get exposed to dust, smoke, pollen, winds, etc?
5. Do you have a running nose or itching of the nose or eyes and watering of eyes along with sneezing?
You appear to have allergic rhinitis. Also in the past, the breathing trouble could have been asthma. Asthma and allergic rhinitis are related and occur together in many patients. However, I cannot be sure of the diagnosis until I see your past reports.
You should go for an IgE antibody test. An elevated IgE antibody suggests allergic rhinitis. Your complete blood count and sputum reports are normal. The absolute eosinophil count and eosinophil percent are normal. The spirometry has a mild abnormality. You have moderate lung restriction, but that is not the cause of your sneezing. This restriction most probably could be a result of the breathing trouble you suffered in the past.
The medications given by your doctor are fine. Those will be the same that I would also give. Some suggestions I would like to make are as follows:
1. Nazomac M spray (Mometasone furoate) should be taken twice daily for two weeks and then daily once for a month.
Each time you should spray both nostrils. When you spray on the right nostril using your left hand and on the left nostril spray with your right hand. Note that the spray should be directed mildly towards the sides of the nose and not the center that is why I have asked to use different hands. The spray should be taken for a long duration, it takes time to act. Also after the spray do not forcefully inhale it. It should remain in the nose.
2. Take Montemac 10 mg (Montelukast) once a day for another 10 days.
3. Take Cetirizine 10 mg only when sneezing is severe. If you feel drowsy, you can take Fexofenadine 120 mg or Levocetirizine 5 mg.
Allergy is not curable. It points to some form of hypersensitivity by your body to some daily routine substances which do not produce allergies in other persons.
However, with the right precautions and care, you can avoid occurrences of allergic symptoms. Also with the right treatment, you can prevent any severity of the symptoms.
1. Smoke, cold winds, pollen, dust mites.
2. Passive smoke and burning substances.
3. Food allergy can be due to milk, nuts, prawns, soy, etc.
Take a diary and maintain your daily activities. Write down meticulously the food you eat also. Suppose you get allergy one day, you note down and see if there was anything suspicious you did because of which you might have developed the allergy. This will help in avoidance of the suspected allergen.
Send me all reports regarding your past history.Differential diagnosis:
1. Allergic rhinitis.
2. Non - Allergic rhinitis with eosinophilia syndrome.
Follow the same treatment plan that your doctor has given in his prescription with the suggestions that I have made above.Preventive measures:
1. No smoking or passive smoking.
2. Drink plenty of lukewarm water. Drink four to five liters of water daily.
3. Avoid cold drinks, alcohol and aerated cool drinks. Take meals hot rather than cold.
4. If working in dust atmosphere try changing your workplace. If not possible wear a mask that prevents inhalation of pathogens.
5. Maintain a diary and consciously note down any incident or food products that triggers allergy.
6. Dry your hair soon after hair wash. Do not apply oil for long duration.
7. Eat nutritious food rich with all vitamins and minerals.
8. For a month take multivitamin supplements such as Himalaya Septillin or AtoZ capsules are good brands.
9. Take plenty of green leafy vegetables, gooseberry every alternate day if not daily, very rich source of Vitamin C.
Revert back with the reports to an allergy specialist online.---> https://www.icliniq.com/ask-a-doctor-online/allergy-specialist
My doctor said that I am suffering from bronchitis. But five years ago, when I went to a child respiratory specialist, on the basis of the test conducted he told me that I am suffering from eosinophilia. But, the medicines which he prescribed are not available now. I also had a checkup with an asthma specialist and I had attached the files and prescriptions given by him.
I am pursuing engineering. When I am exposed to dust or smoke, I use to cover my nose and mouth with a hand or handkerchief. My current problem is that I sneeze around 10-20 times in the morning. Sometimes, this sneezing increases and if I do not take medicine then it will lead to getting cold, fever, and watering of the nose. In winter, I get a fever and cold. I do not drink or smoke.
Welcome back to icliniq.com.
I have gone through the reports (attachment removed to protect the patient's identity).
The breathing trouble in the past could be bronchitis like your doctor said. Bronchitis is a general term, it can be due to allergy, viral or bacterial infection, etc.
Eosinophilia is a condition where eosinophil cells in the blood are raised. This is closely related to allergy. Hence, there is no contradiction between the two doctors. However, I cannot be sure of these things unless I examine you personally and auscultate you. However, I need the report of serum IgE. That will help us conclude it is an allergy. With the symptoms, you have described and with the prescriptions, you have attached I understand that you have been treated for allergic rhinitis only.
My current diagnosis based on what we have conversed is allergic rhinitis. Continue the most recent treatment with the suggestions I have given. Please do it meticulously for 2 to 3 weeks and see the improvement. Also, understand that this condition will take time and may not resolve entirely. You have to be careful to avoid exposure to allergens.
The prescriptions given must have cleared your breathing trouble. Do you still have breathing trouble? Are you taking any inhalers for any breathing trouble?
You must try wearing a mask when you go outdoors and in dusty places. Covering with a handkerchief is not as effective as with a mask. Also, handkerchiefs can get dirty and soiled. Covering with hands does not help much. I reiterate that you must follow my suggestions and precautionary measures to get good relief from this problem.
If your condition does not improve till 2 months from now despite following religiously all that I said, then we may try and find out through skin tests which compound you are allergic to. In addition to skin tests, RAST (radioallergosorbent test) can also be done which is more specific to allergens. Next, after identifying the compound we can try for hypo-sensitization or desensitization of you with regards to that compound. Some other advanced methods for immuno-modulation are sublingual or subcutaneous immunotherapy.
Immunotherapy needs to be considered only if the environment control and drug therapy have failed and you have severe allergic symptoms with complications. Some newer sprays available for the treatment of allergic rhinitis are,
1. Intranasal antihistaminics: Azelastine (the Duonase spray has Fluticasone and Azelastine).
2. Intranasal anticholinergic: Tiotropium and Ipratropium bromide.
3. Intranasal cromolyn: These are mast cell stabilizers.
If no improvement with the current treatment, taken for two weeks or more, then we can think of starting one of the other methods of treatment.
1. Serum IgE.
2. Allergic skin tests, RAST.
1. Allergic Rhinitis.
2. Allergic Bronchitis.
Revert back after two weeks for follow up to an allergy specialist online.---> https://www.icliniq.com/ask-a-doctor-online/allergy-specialist
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