Brief Answer:
Add montelukast, allergy testing & immunotherapy

Detailed Answer:
Hello XXXXXXX

Thank you for asking at HCM.

Before suggesting treatment of allergic rhinitis, I would like to know more about you like -

a. Since what age do you have allergic rhinitis?
b. What are your nose symptoms - nasal itching, sneezing, nasal congestion, running nose?
c. How are your symptoms with use of current medications?
d. Do you have fevers?
e. Do you have headaches, facial pains/heaviness, loss of smell, ear complaints or recurrent throat clearing?
f. Do you have any other allergies - skin allergies, food allergies, eye allergies (redness, itching, watering) etc currently or in past?
g. Do you have cough, difficulty in breathing or wheezing currently or any time in past? Did you ever require nebulization?
h. Do you have anyone in family with allergies?
i. What is the frequency of your symptoms?
j. What are the worst seasons for you?
k. Do you have any other medical conditions currently or in past?
l. Do you need to take any medications regularly/frequently for any other condition?
m. Have you ever had allergy testing? If yes, can you please upload the reports?
n. Are you regularly exposed to dusts, smokes or air pollution?
o. Can you please let me know your occupation?

I would be able to help you more accurately if you could provide my above details on follow-up.

At present, I would like to make following suggestions to you:

1. Were I treating you, I would suggest you to continue intranasal spray (Duonase) regularly.

2. If you are not comfortable with spray alone, I would add regularly montelukast to your treatment.

3. Personally I would suggest you to avoid exposure to dusts, smokes and air pollution in general.

4. I would suggest you allergy testing for common air-borne allergens like house dust mites, common molds and pollens in your region and animal dander (if you have pet).

Based on allergy testing report, an Allergist-Immunologist may prescribe you allergen specific immunotherapy which works on immune system to improve your allergy symptoms for long term.

5. I would suggest you regular breathing exercises and a healthy diet rich in vitamins, minerals and anti-oxidants (adequate amounts of green leafy vegetables, fruits, sprouts, etc) to improve your lung capacity and immunity respectively in a long run.

Hope above suggestions will be helpful to you.

As you have asked for long term solution, allergen specific immunotherapy, life style & nutrition changes as well as alternative therapies like herbal/ayurvedic medicines can offer long term relief from allergies. Appropriate allergy testing is necessary before suggesting immunotherapy.

Please feel free to ask any other query that you may have. It will be my humble pleasure to help you with best of my knowledge and experience.

Wish you the best of the health.

Thank you & Regards,

Dr. Parin N. Parmar

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Brief Answer:
Drugs, allergen avoidance & lifestyle changes

Detailed Answer:
Hello XXXXXXX

Thank you for your follow-up and details.

I went through your details and would like to add to my previous suggestions as follows:

1. As you are comfortable with current medications, I would like to let you know following:

a. Duonase contains two drugs - intranasal corticosteroids (fluticasone propionate) and intranasal antihistamine (azelastine hydrochloride).

Allegra is an oral antihistamine tablet (fexofenadine).

You can use the minimum drugs to control your symptoms. Also, fluticasone and azelastine are available singly in spray forms.

b. In my opinion, I would suggest you to use Duonase nasal spray and montelukast (10 mg) at present.

Once your symptoms improve, you can use only fluticasone spray + montelukast.

After further control, I would suggest Azelastine spray + montelukast.

You can adjust them according to severity of your symptoms and seasons.

2. As you have headaches, facial pains/heaviness & ear problems, it suggests possibility of nasal obstruction and affection of sinus.

In addition of treatment of allergic rhinitis, I would suggest you regular steam inhalation (please be cautious to avoid burns). It helps very much in rhinosinusitis (involvement of both nose & sinus).

3. I would like to know whether you have gastroesophageal reflux symptoms - regurgitation of foods/fluids especially after spicy meals, heart burns, nausea, vomiting, etc.

In that case, I would suggest you regular antacid like pentoprazole before meals for at least 6-8 weeks.

4. I would suggest you allergy testing same as for your daughter:

a. House dust mites (D. farinae & D. pteronyssinus)
b. Cockraoch allergens
c. Common molds & pollens in your area
d. Animal dander (act, dog, cow, XXXXXXX etc if you are exposed to an animal/pet)
e. Common food allergens - milk, egg, soy, peanut, wheat, rice, tree nuts, fish, shell fish, etc. I would like to add eggplany, flat beans, as you already have had reactions to them.

Avoidance of foods and environmental measures for air-borne allergens is very important for treating allergies.

Allergen specific imunotherapy can be prescribed by an allergist for some allergens.

5. As you are exposed to dusts, smokes and air pollution, I would suggest you their avoidance by appropriate personal protection measures like full helmet while driving, covering nose with cloth, using face mask, etc.

Please note that dusts, smokes and air pollution do not cause "allergies" so they cannot be tested. But they directly damage respiratory system without causing allergies and therefore worsen allergy symptoms.

6. Were I treating you, I would suggest you vitamin C, vitamin D and a good multivitamin-mineral supplement for at least 2-3 months.

7. As you are an IT professional, air conditioners, dusts from keyboards/screen can be additional factors worsening your symptoms.

8. Mental stress is an important factor affecting adversely immune system and therefore allergies. I would suggest you meditation & relaxation if it is an important factor for you.

9. As previously suggested Breathing exercises (including Yoga & Pranayama) and a balanced diet are equally important in my opinion.

Hope above suggestions will be helpful to you.

Should you have any further query, please feel free to ask on follow-up.

Wish you the best of the health.

Thank you & Regards.

Dr. Parin N. Parmar

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