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What Causes Persistent Allergic Rhinitis Despite Taking Medication?

Posted on Wed, 23 Dec 2015

Question: I suffer from severe sinus and chronic cold. My sinus problem is severe in high pollen season and regions with dust. I have seen several ENT specialist during last decade but no permanent cure. I have had nasal septum reconstruction surgeries twice. But the same symptoms appeared after a year. If I walk in cold weather without a sweater/jacket and hat, I get cold. I have to wear sweater and hat during sleep in winter. I have tried almost all prescription and non-prescription nasal sprays. They help a little. I take Flonase nasal spray and Claritin antihistamine everyday year around. I do sinus rinse once or twice daily. I lubricate my nostrils with vegetable oil or ayurvedic oil. But still suffer from sinus. I have started taking bee pollen (1 tea spoon daily) six weeks ago. But not much benefit. If I don't cover my chest and heat, I get cold. In summer, fan and AC makes me sick.

Answered by Dr. Drkaushal85 (1 hour later)

Brief Answer:
Better to take combination of antihistamine and anti allergic drugs.

Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your concern.
By your history and description, possibility of allergic rhinitis is more.
Best treatment of allergy is identification of allergen and if possible complete avoidance of it.
So in your case try to avoid pollens, dust etc. Wear face mask all the time.
In place of Claritin, you should take combination of antihistamine and anti allergic drugs.
Combination of antihistamine (levocetrizine or fexofenadine) and anti allergic (montelukast) drugs is more beneficial than plain Claritin.
Also take nasal spray containing combination of azalastine and fluticasone instead of fluticasone (Flonase) plain.
Please let me know
1. Have you ever undergone serum IgE level?
Please reply me answer of above asked question, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (23 hours later)

Thank you doctor for your response. I have never gone through the serum IgE level.
Regards

Answered by Dr. Drkaushal85 (20 minutes later)

Brief Answer:
Better to get done IgE level first.

Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
In my opinion, you should first get done serum IgE level. Serum IgE is the marker of allergy. If it is raised then immunotherapy can be helpful.
Please let me know
1. Have you ever taken montelukast, levocetrizine or fexofenadine combination?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (7 minutes later)

Thank you doctor for your quick response. I have never taken montelukast, levocetrizine or fexofenadine combination.
Regards.

Answered by Dr. Drkaushal85 (9 minutes later)

Brief Answer:
In my opinion, you should consult allergy specialist.

Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
In allergic rhinitis, montelukast should be started if it is not controlled by antihistamine alone.
And fexofenadine or levocetrizine should be started because they are more potent than Claritin (loratidine).
And they are more effective when taken with montelukast.
So in my opinion, you have not consulted appropriate doctor.
Please let me know
1. Have you ever consulted allergist?
2. Have you ever undergone allergy testing?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (16 minutes later)

Thanks doctor. Yes, I had consulted an allergist several years ago when I was living in a different city. (But my problem has become worse in last 2 years). I went through the allergy test several years ago. The allergist recommended that I should not go through the allergy treatment because the allergy test result was not that severe. He rather referred me to an ENT specialist who performed deviated nasal septum surgery. That was second that kind of surgery for me. After the surgery he put me on a special nasal spray for six months. This nasal spray was being made specially for me by a small pharmacy. That really cured me but the symptoms started again after 6 months of stopping that spray.
Regards.

Answered by Dr. Drkaushal85 (5 minutes later)

Brief Answer:
Were you taking only Flonase?

Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
I am little confused.
You said that you are taking Claritin and Flonase. Now you are saying that you have stopped Flonase since 6 months.
Please let me know
1. At present which drugs and nasal spray you are taking?
2. Were you taking only Flonase?
3. Have you ever tried azalastine and fluticasone combination nasal spray?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (15 minutes later)

I'm sorry doctor for the mix up. When I said I stopped taking nasal spray, I was talking about several years ago. At that time I used special nasal spray made by pharmacy for me. Anyway, currently I am taking Flonase and Claritin daily.

Yes, I tried combination of azalastine and fluticasone. It improved the condition a little. I stopped azalastine after a few months because my head was not feeling right. So I only used the combination of these sprays for just a few months. And that was about 8 months ago. Thanks.

Answered by Dr. Drkaushal85 (46 minutes later)

Brief Answer:
Better to start combination of levocetrizine or fexofenadine and montelukas

Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern now.
In my opinion, you should continue Flonase nasal spray. Instead of plain Claritin, you should take combination of levocetrizine or fexofenadine and montelukast.
Also consult allergist too. Discuss about immunotherapy and it's benefits in your case. Wear face mask all the time you are exposed to dust and pollens.
You need to take these drugs and nasal spray for life long or at least till immunotherapy.
Hope I have solved your query. If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on XXXX
Wish you good health. Thanks.

Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar