Does my constant sneezing indicate allergic rhinitis?

Hello,

Welcome to icliniq.com.

I understand your concern.

I have reviewed your reports (attachment removed to protect patient identity) and need some additional information to make a more definitive diagnosis:

1. Regarding your breathing problems and eosinophilia, what specific breathing issues did you experience in the past?
2. What medication did your doctor prescribe for you? If you have any reports, prescriptions, or test results, please attach those in your next message.
3. How many times do you sneeze each day?
4. Do you smoke or drink alcohol?
5. Are you currently employed? If so, what are the atmospheric conditions at your workplace? Are you exposed to dust, smoke, pollen, or wind?
6. Along with sneezing, do you have a runny nose, itching of the nose or eyes, or watery eyes?

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. Mometasone furoate spray should be taken twice daily for two weeks and then daily once a month.
2. Each time, you should spray both nostrils. When you spray on the right nostril, use 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.
3. Take Montelukast 10 mg once a day for another 10 days.
4. Take Cetirizine 10 mg only when sneezing is severe. If you feel drowsy, you can take Fexofenadine 120 mg or Levocetirizine 5 mg.

Preventive measures include avoiding smoking and passive smoke, as well as drinking plenty of lukewarm water. It is advisable to steer clear of cold drinks, alcohol, and carbonated beverages and to consume hot meals rather than cold ones. If you work in a dusty environment, you should consider changing your workplace if feasible; otherwise, you should wear a mask to prevent inhaling pathogens.

Keeping a diary to track incidents or food products that trigger allergies can be helpful. Dry your hair promptly after washing and avoid leaving oil on your hair for extended periods. Eating a nutritious diet rich in vitamins and minerals is essential, and taking multivitamin supplements for one month can be beneficial. Additionally, incorporate plenty of green leafy vegetables and consume gooseberries every other day or daily, as they are an excellent source of Vitamin C.

Allergy is not curable. It points to some form of hypersensitivity by your body to some daily routine substances that do not produce allergies in other people. 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.

I hope this helps.

Thank you.

Hello,

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 infections, etc.

Eosinophilia is a condition in which eosinophil cells in the blood are raised. This is closely related to allergies. 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 about is allergic rhinitis. Continue the most recent treatment with the suggestions I have given. Please do it meticulously for two to three 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.

1. Do you still have breathing trouble?
2. 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 two months from now despite religiously following 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 hyposensitization or desensitization of you with regard to that compound. Some other advanced methods for immunomodulation 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 antihistamines: Azelastine (the Duonase spray has Fluticasone and Azelastine).

2. Intranasal anticholinergics: Tiotropium and Ipratropium bromide.

3. Intranasal cromolyn: These are mast cell stabilizers.

If there is 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.

I hope this helps.

Thank you.