Brief Answer: Symptoms suggestive of ongoing nasal allergy Detailed Answer: Hi Ms. XXXXXXX Thanks for posting your query on this forum. Your medical history and known allergies indicate that you have allergic asthma (called Naso-Bronchial Allergy), that is, allergy in the nose, sinuses and throat + lungs. The persistent symptoms are apparently allergic in nature, with consequent sinus infection which has trickled down to the lungs, due to either * a viral infection involving the entire respiratory tract * fungal (mold/yeast) infection of the respiratory tract, as you are on inhaled steroids. * Persistent exposure to a new, yet unidentified allergen (environmental, a food or a new drug). Bacterial infection (or decayed teeth) is highly unlikely as it does not persist for prolonged duration, particularly after two courses of antibiotics. So, I would recommend that you get a throat swab culture done to isolate the offending organism (yeast/virus), if any; a Chest X-ray to see for viral/yeast infection; X-ray/MRI of sinuses for evidence of collected secretions/infection. Since you are looking forward to a well-earned vacation, I would recommend the following course of action :- 1. Give a throat swab sample for analysis and, a Chest X-ray done PRIOR to departure for Spain. Your reports would be ready by the time you return. 2. In addition to your regular dose of Ventorlin + Seretide, START WITH anti-allergics as below:- (a) Oral Methylprednisolone, starting with 32mg once a day for at least 2 weeks; thereafter, the dose can be reduced gradually by 6mg every week. (b) Levocetirizine 5mg Twice daily OR, Cetirizine 10mg thrice daily (c) Montelukast 10mg twice a day (d) Azelastin Nasal spray twice a day (e) Nasal decongestant drops/spray four times a day for 7-10 days. I am sure that you will show rapid improvement, with your symptoms reducing to minimum within 5-7 days. Once you return from Spain and your throat swab reveals yeast, a 2-3 weeks' course of anti-fungal drug (such as, Fluconazole) will cure the infection completely. Consult your doctor and apprise him of my opinion. I am certain that he will agree with me; order required tests and, prescribe suitable treatment as advised. Hope I have addressed your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Have a nice day, Col (Dr.) Rakesh Karanwal

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