Brief Answer:
Intranasal mometasone, steam inhalation

Detailed Answer:
Hello XXXXXXX

Thank you for asking at HCM.

I went through your history and would like to ask a few more questions to know more about your complaints:

a. What are your nose symptoms? - nasal itching, nasal obstruction, running nose, sneezing, etc. What it the type of nasal discharge?

b. Do you have symptoms like headache, facial pain/heaviness or loss of smell? Do you have fevers?

c. Since what age your symptoms started? How they progressed?

d. What is the frequency of your symptoms apart from winter?

e. Do they occur more often in day time or night time? Do they more occur at work place or home?

f. Have you ever had wheezing or breathing difficulty? If yes, when at how frequently?

g. Have you ever had any type of skin allergies like dermatitis or urticaria/hives?

h. Is there any particular food that aggravates your symptoms?

i. Are you exposed to smokes/dust/air pollution? Do you have pets?

j. Does anyone from your family have any allergies/asthma?

k. What are the medications you have used so far, apart from Allegra? How frequently you use them?

l. Do you have any other medical conditions? Do you need to use any medicines frequently/dily?

m. Have you ever been tested for allergies? What are the reports? Have you had any other reports any time?

n. Have you been examined by an ENT surgeon any time? Have had any CT scan of sinuses done? Or, how you sinus problem was diagnosed? Have you ever had any surgery?

o. Do you have any digestion problem? Do you feel regurgitation of foods or burning in chest, especially after hot, spicy meals?

Above details will help me better to know more about you, so that I can more specifically help you regarding management. Please let me know above details on follow-up.

At present, in reply to main question, I would like to make suggestions to you as follows:

1. Were I treating you, I would prescribe you intranasal corticosteroids (mometasone or fluticasone propionate) for at least 2 weeks.

Please be sure that intranasal corticosteroid sprays are very much different from corticosteroid tablets because they act locally in the nose and are least absorbed in blood.

2. It is very important to follow proper technique while using these sprays like - a. exhaling before use, b. while inhalation, spraying towards side (alae) of the nose and not towards the bridge of the nose, c. after inhalation, exhalation through mouth and not through nose. (the technique is described on most of the sprays)

3. I would also prescribe you a combination of montelukast and cetirizine/levocetirizine/fexofenadine for at least 2-4 weeks. I would suggest you to continue after you stop intranasal corticosteroid sprays when your symptoms have been improved.

4. Personally, I would also suggest you daily steam inhalation (please be cautious to avoid burns) and nasal irrigation with saline sprays. This will help you for early recovery.

5. If you have frequent fevers, I would prescribe you a course of an antibiotic like amoxycillin-clavulinic acid for 14 days.

6. I would suggest you to avoid exposure to dusts, smokes and air pollution.

7. Regular breathing exercises like Yoga and Pranayama and a balanced diet rich in vitamins, minerals and antioxidants (like adequate amounts of green leafy vegetables, fruits, sprouts, etc) will improve both your lung capacities and immunity respectively and will help you on long run.

8. I would suggest you allergy testing which will help you identifying the substances causing troubles to you and also to know the measures to avoid them.

Depending upon results, an Allergist-Immunologist can also prescribe you Allergen Specific Immunotherapy which will modify your immune system to reduce allergy symptoms on a long run.

9. As you have asked for home remedies, it depends upon your XXXXXXX

a. In general, use of spices like ginger, pepper, turmeric, clove and cinnamon are better for persons prone to colds and sinuses.

b. Daily steam inhalation with a few drops of eucalyptus oil in boiling water also helps.

c. A mixture of 1 spoonful each of ginger juice and honey is also a remedy that I prescribe to my patients.

Hope above suggestions and information will be helpful to you.

Should you have any further query, please feel free to ask on follow-up. Please give me other details as asked above on follow-up, it will help me to understand your disease better.

It will be my humble pleasure to help you with best of my knowledge and efforts.

Wish you the best of the health.

Thank you & Regards,

Dr. Parin N. Parmar

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Brief Answer:
Allergy testing, continue drugs

Detailed Answer:
Hello XXXXXXX

Thank you for your follow-up with details. I went through your details.

1. I would like to know what kind of allergy reports were done and also what kind of operation was done. Because, usually, surgeries are done to correct structural problems, not for infections unless complicated sinus infections.

2. Were I treating you, I would suggest you following reports: Serum total IgE and Phadiatop-Adult. If Phadiatop-Adult is positive, I would suggest you to consult an Allergist-immunologist who will suggest you specific allergy testing (skin tests or specific IgE tests) depending upon common allergens (allergy causing substances) in the region you live.

Usually I include house dust mites, cockroach proteins, common molds and pollens in my area to perform allergy testing of my rhinitis patients.

Above reports can help to decide whether your symptoms are contributed by allergies significantly or not.

this testing is useful to know whether you are eligible for allergen specific immunotherapy or not.

3. Rest of the treatment suggestions will be same as I had mentioned in my previous answer.

Hope above suggestions will be helpful to you.

Please feel free to ask any query on follow-up.

Thank you & Regards.

Dr. Parin N. Parmar

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Brief Answer:
Of course, please send reports

Detailed Answer:
Hello XXXXXXX

Sure, I will review them and will try my best to help you.

Thank you & Regards,

Dr. Parin N. Parmar

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