Hi


Thanks of posting the query

You seem to be having allergic rhinosinusitis which is not responding to the medicines.

To make things clear for you, first of all, you need to stop using Allegra D and Zyrtec together. You can use plain Allegra instead of Allegra D. Zyrtec and Allegra both being antihistaminics, when used together dries up the nasal mucosa and alters the mucociliary clearance and also, increases the consistency of the nasal secretions. When this is used along with pseudoephedrine ('D' in Allegra D) the situation will further worsen. On top of it, you are also using steroid nasal spray, which will worsen your symptoms much more.

Secondly, the content of benzalkonium used in the saline nasal spray is very minimal and doesn't harm the nasal mucosa when used for short duration.

My suggestions to you are:
1. Drink plenty of warm water, this keeps the tissues hydrated and reduces the inflammation of the nose and the para nasal sinuses.

2. Use saline nasal spray other than Ocean spray. If you are able to get XXXXXXX nasal spray or nasoclear nasal spray or rhinomer force nasal spray, please use it three to four times a day, followed by steam inhalation. Saline spray keeps the mucosa moist and helps in easy clearance of the sinus secretions. Steam inhalation opens up the sinus blockage and relieves headache and sinus tenderness.

3. Please continue with steroid nasal spray once in the morning as soon as you get up from the bed. This is beneficial in reducing the early morning symptoms of nasal allergy.

4. Continue with the regular allergy shots and use plain Allegra for the prophylaxis.

5. Also, continue Singular regularly; don't have to use any antihistaminics along with that. You can use antihistaminics only if needed, when there is flaring of the allergic symptoms.

6. Apart from the above measures you can use neti pot for nasal douching. When doing nasal douching please use warm normal saline. Normal saline infusion bottles are avialable in the pharmacy, you can get them, warm the solution to around 37 degree centigrade and do nasal douching; avoid distilled water.

7. Finally, you need to remember one thing, there is 'no cure for allergy', prevention is the best treatment. Avoid contact from allergens and you will be alright without any medicines.
A. Change the pillow covers every night before going to bed.
B. Avoid sleeping under the fan or in front of the air conditioner.
C. When exposed to dust or fumes cover your nose with a clean handkerchief.
D. Avoid pets and carpets at home.

Hope with the above measures you will be alright. Revert back to me if you have any further queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Hi

Welcome back

1. If your allergic symptoms are bad you can request your doctor to put you on Singulair. Once you start using Singulair do not stop it immediately, it has to be tapered before stopping. Avoid taking Singulair and Allegra together, instead, use Allegra when the symptoms flare up and on the day of taking allergic shots. 'Prophylaxis' means to prevent future allergic episodes.

2. Saline nasal spray is available as over the counter medicines, you can try it from any pharmaceutical shops in your town. The reason I told you to avoid ocean spray is, it causes mild irritation as well as some amount of drying of the nasal mucosa (this is my observation during clinical practice). Please check out the following links:

http://www XXXXXXX de/htmle/application_of_nisita_nasal_spray.htm

WWW.WWWW.WW
I wish you good health and good luck.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Hi

Thanks for writing back

Distilled water takes away the salt content from the nasal mucosa and makes it dry. Hence it is always wiser to use isotonic saline because it resembles the normal body plasma constituents and keeps the gel layer over the nasal mucosa alive.

Pleas check the following link:
WWW.WWWW.WW
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Hi

Welcome back

As you were irregular in taking the allergic shots before, it is wiser to use Allegra after the shots for a month or two, later, you can use it only when the symptoms of allergy are present.

At present, if you do not have any allergic symptoms please do not take any oral medicines, but continue with the nasal steroid and saline spray. If at all, you develop the allergic symptoms at any stage you can start on Singulair (monteleukast) combined with the nasal sprays. While on this regimen, if at all by any chance, there is a flare up of the symptoms, you can add Allegra to the regimen only for that moment, till the symptoms stop.

Montelukast is an oral leukotriene receptor antagonist. Leukotrienes are a group of naturally occurring chemicals in the body that promote inflammation as in asthma and seasonal allergic rhinitis. They are produced by cells, released, and then bound to other cells that cause inflammation. It is the binding to other cells that stimulates the cells to cause inflammation. Montelukast works by blocking the binding of some leukotrienes to the cells that cause inflammation.

Antihistamines are used to relieve or prevent the symptoms of hay fever and other types of allergy. They work by preventing the effects of a substance called histamine, which is produced by the body. Histamines are produced in response to immune reaction by a foreign substance which can cause itching, sneezing, runny nose, and watery eyes.

Histamines and the leukotrienes are released in concert during early phase of allergic reaction. As monteleukast has also got some properties of antihistamines, it can be started as monotherapy along with intranasal corticosteroids and saline spray.

Please check this article for your further reference. WWW.WWWW.WW

Hope this clarifies your doubts; I will be available for the further queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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