Brief Answer:
Intranasal steroids, monteluakst and antihistamine

Detailed Answer:
Hello Mr XXXXXXX

Thank you for asking at HCM.

I went through your history and would like to make suggestions to you as follows:

1. First of all, I would like to know more about you like -

a. Since what age you are having allergy problems?
b. Is there any particular season when they get worsened?
c. Apart from nose symptoms, do you have eye symptoms like itching, excessive watering, red eyes, etc?
d. Do you have cough? Do you have recurrent need to clear throat? Do you have headaches or facial heaviness?
e. Do you have/have you ever had wheezing or difficulty in breathing in past? If yes, when and with what frequency?
f. Have you been examined by an ENT surgeon any time? If yes, what are his findings? Since when do you have nasal polyp?
g. Do you have any other medical conditions apart from this allergy problem?
h. Do you need to take any other medicines on regular/frequent basis? If yes, what are they and since when?
i. DO you smoke or did you smoke in past?
j. Do you have anyone in family with allergies?

Above information will help me to understand your complaints better, please feel free if you want to add anything else. Please let me know above details on follow-up.

2. At present, I would suggest you combination of montelukast and an antihistamine like levocetirizine daily before going to bed and intranasal corticosteroid sprays (mometasone or fluticasone propionate) daily in the morning for at least 14 days.

3. Personally, I would not suggest you to take Wysolon (Prednisolone - an oral corticosteroid) for more than 3-5 days unless suggested by your doctor.

4. Hetrazan may or may not be helpful in patients with high eosinophil counts. You can take it if your doctor has suggested.

5. The best test to diagnose allergies is specific IgE testing for various allergy causing substances. After going through you complaints, I would suggest you allergy testing for specific IgE for house dust mites, common indoor molds, common insects proteins, and common pollens in your region.

I should mention here that this type of allergy testing is available at specialized centers only.

6. Allergy testing will help you identify the substances you may be allergic to and also to know the measures to avoid them.

Based on allergy testing report, an Allergist-Immunologist may prescribe you allergen specific immunotherapy which gradually improve allergy symptoms by working on immune system.

7.I would suggest you to continue warm saline gargles and steam inhalation daily and it would be desirable if you could make it part of you daily routine till your all complaints subside or unless you have any problems due to that.

8. In general, I would suggest you to avoid exposure to dusts, smokes and air pollution. I would also suggest you to avoid rapid temperature changes (like going from bright sun into cool AC or vice versa).

9. I also suggest my such patients regular breathing exercises like Pranayama and a nutritious diet rich in vitamins, minerals and anti-oxidants (e.g., plenty of green leafy vegetables, fruits, sprouts, etc) which improves your lung capacity and immunity respectively and will help you in a long run.

10. Before making comment on polyp surgery, I would like to know more about your polyp as asked above.

Hope above suggestions will be helpful to you.

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 experience.

Wish you the best of the health.

Thank you & Regards,

Dr Parin N Parmar

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