Brief Answer:
Use medicines wisely, Immunotherapy may help

Detailed Answer:
Hello.

Thank you for asking at HCM.

I went through your history and understand your concern about long-term use of medicines.

I would like to know more about your symptoms like -

a. Since how long you are having nose allergies?

b. Do you have off-and-on fever, headaches, facial pain, loss of smell, repeated throat irritation/throat clearing?

c. Have you ever investigated for allergies? What are your latest investigations?

d. Are you exposed to dusts or smokes regularly?

e. Do you have any other allergies? Have ever had wheezing/breathing difficulty?

f. Do you have any other medical condition?

g. Do you take any other medicine(s) frequently/regularly?

h. Have you had any surgery in nose region?

I would like to make following suggestions to you:

1. Were I treating you, I would prescribe you intranasal corticosteroid sprays (mometasone or flluticasone propionate) for minimum 2 weeks. I would also add montelukast and an antihistamine like cetirizine/levocetirizine/fexofenadine regularly for 2-4 weeks (depending upon response).

2. I would like mention that intranasal steroids are very safe as compared to betnesol (betamethasone - a corticosteroi) tablet. Because nasal sprays have maximum local effects and only less that 1% part goes into blood, while oral steroids first go into the blood and so they have more side effects.

3. As you have nasal polyp, it suggests you have a long standing nose allergies. Personally I would suggest you to consult an ENT surgeon who will examine both the nose cavities and also will let you know the size and types of polyps. Small nasal polyps may regress with intranasal corticosteroids, but bigger ones may require surgery.

4. Personally I would like to suggest you to minimize intake of analgesics like aspirin, ibuprofen or other pain killers, because many times they are linked with nasal polyps. Avoiding them will improve your allergy symptoms also. If any pain killer is required, I suggest only paracetamol to my nose allergy patients.

5. Personally I would suggest you allergy testing as allergic rhinitis is a possibility. This will help you to identify the substances you may be allergic to and also to know the measures to avoid them.

6. Please avoid exposure to dusts, smokes and air pollution as much as possible.

7. A healthy diet rich in vitamins, minerals and anti0oxidants (that is, adequate amounts of green leafy vegetables, fruits, sprouts, etc) will also help you in a long run.

As you have specifically asked for duration and side-effects of medications, I would like to summarize as follows:

1. Antihistamines like cetirizine (Cetrizen), levocetirizine, fexofenadine etc can cause most commonly sedation, drowsiness. These side effects are only seen after you take the dose and there are no long-term side effects after stopping usage.

2. Montelukast (that I have suggested) is considered very safe for long term use. Its common side effects are nausea, vomiting, headache. If you are not experiencing them, you can take it for long time.

3. Betnisol (Betamethasone) is an oral corticosteroid. It should be used only for short time, only for very severe symptoms (where other medicines fail) and only under doctor's advise. With frequent/long term use, it can cause gastritis, hypertension, weight gain, diabetes mellitus, cataract, glaucoma, osteoporosis, supressed immunity, some hormonal disturbances, etc.

4. Intranasal corticosteroids can cause local side effects like nasal burning, irritation, bleeds. If they are used with correct technique, they are safe considered safe for long term use. Side effects of oral steroids mentioned above are very rare with them because they act more locally. If direction of spray is towards bridge of nose, it rarely can cause nasal septum perforation with long term use.

5. Common side effects of amoxicillin are allergic reaction, gastric upset, mild diarrhea. However, it is not required if one does not have infection. It is not a drug for allergy.

6. All the allergy medications control and improve allergy symptoms over long time. However, they cannot "cure" allergy process, which is basically an abnormality of immune system. So you need to take medicines as long as you have symptoms. Of course, with improvement in symptoms, you can manage with least amount of medications.

7. If allergy testing reveals any specific allergen (substance causing allergy), an Allergist-Immunologist may suggest you Specific Allergen Immunotherapy, which works on immune system to improve your allergy symptoms. However, it take a few weeks for it to become effective and has to be continued for at least 2-3 years.

In modern science, only Allergen Specific Immunotherapy is considered an option close to "cure" of allergies.

Hope above suggestions and information will be helpful to you and will assist you to make better choices.

Should you have any further query, please feel free to ask on follow-up. It will be my humble pleasure to help you with best of my knowledge and efforts.

I will be thankful to you if you would give me feedback on follow-up.

Wish you the best of the health.

Thank you & Regards.

Dr Parin N Parmar

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Brief Answer:
Consult an Allergist for Testing & Immunotherapy

Detailed Answer:
Hello.

Thank you for the follow-up.

Reviewing your follow-up details, I would like to make following suggestions to you in addition to all those made in my 1st reply:

1. Personally I would suggest you to get allergy skin testing done for at least following substances: house dust mites, common molds in your area, common pollens in your area, cockroach, animal dander (if you have pets).

Personally I would not suggest you to go for blood testing for allergies to all above substances because - a. Skin testing is the best & most reliable method to diagnose allergies. b. Blood testing is very expensive. c. Many of blood tests for allergies are not reliable.

2. Depending on results of above test, it may be possible to advise you regarding specific allergen immunotherapy.

Specific allergen immunotherapy is a long term treatment which works like vaccines. It gradually changes your immune system to improve your allergy symptoms. Once started, I would always advise my patients to continue it for at least 2-3 years, sometimes up to 5 years.

3. Personally I would suggest you to consult an qualified and experienced Allergist-Immunologist in your city/region. Because as mentioned above, your Allergist-Immunologist should be knowing about all the pollens,molds etc which are present in your region.

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