Hi,

Thank you for your query.

1. You have developed a condition known as Rhinitis Medicamentosa due to continuous use of decongestant nasal drops (Nasivion). The nasal mucosa (lining) becomes dependent upon continuous use, failing which the nose gets blocked.

2. Get an AEC (Absolute Eosinophil Count) done. a course of Heterazan may help lower your eosinophil count.Do you have any Sinuses) done? I would like to review the images if you have nasal obstruction.

3. In such a situation Intrinsic or Vasomotor Rhintis may also exist. Have you had a nasal endoscopy and if yes, what were the exact clinical findings? The color and appearance of the nasal lining (mucosa) givesa fairly accurate idea of the type of rhinitis. For example, in allergy it is reddish purple, in vasomotor rhinitis it is red and in long standing allergy, it is pale white. Bogginess indicates an active inflammatory process. Discuss this with your physicians.

4. New technologies such as Radio-Frequency and Co-ablation coagulate tissue at under 100 degrees C and in more controlled fashion. These would be of use if you have significant nasal obstruction.

5. I would recommend the use an anti histamine, an anti leukotriene, a steroid nasal spray such a mometasone, fluticasone or ciclesonide (not a decongestant, which cause rhinitis medicmentosa) and steam inhalation with saline nasal washes for at least two weeks under medical supervision and then reassess.

6. The steroid sprays and saline nasal washes are necessary along with discontinuation of nasal decongestants to get over the Rhinitis Medicamentosa.

7. There is no need to avoid the steroid nasal spray as the steroid content is very low and in 50 - 65 micro grams. Our bodies also produce 5000 to 7000 micro grams of steroid every day and it is essential for life. Most steroid complications occur only after intake of this amount is exceeded for a long time. Newer sprays such as mometasone and ciclesonide are absorbed only up to 0.1% of the dose which is negligible. hence these sparys can be used for many months.

8. Another interesting point is that the above treatment will require at least 7-10 days to show it's effect fully.

Hope I have answered your query. You may need to fill in some information. If you have any follow up queries I will be available to answer them.

Regards.

---

Hi,

Thank you for writing back.

1. I would suggest that you start using the above course of medication (under medical supervision) for at least 15 days along with the nasivion drops an then discontinue the nasivion.

2. A raised eosinophil count is not normal. Among its many effects are increased allergic symptoms (they play an important part in allergy), feeling ill and dry cough (Tropical Eosinophilia). The dose of Tab Hetrazan is 100 mg thrice a day for one to two weeks. However this should be decided only after the AEC (Absolute Eosinophil Count) and again under strict medical supervision.

3. The effect of these medications will not last longer than a day or two. You may get checked after this time period.

4. I have recommended a full course of treatment under medical supervision and not steroid spray alone. Each drug in the combination acts on a different point of the allergy cycle. Together, their effect is more than each used separately.

5. There is no cure for allergy, It may only be controlled. Newer steroid sprays neither cause a bad taste in the throat nor any cough.

6. Nasal blockage in cold air is a non specific allergy and is very common. If this does not respond to medical treatment after 15 days trial, get the plain CT PNS (Para Nasal Sinuses) done with 1 mm coronal , axial and saggital cuts. This scan may be done pre and post decongestion with Otrivin nasal drops. You may share the images here.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.

---

Hi,

Thank you for writing back.

You should use Hetrazan only if your AEC is more than 440.

I hope that I have answered your queries.

If you have any further questions, I will be available to answer them.

Regards.

---