Brief Answer:
Please provide more details, antihistamines for symptom relief

Detailed Answer:
Hello XXXX,

Thank you for asking at HCM. I went through your details and would like to know more about your problem as follows:

a. For how long have you had this problem?

b. Do you have symptoms in a particular toilet (at your home) or at other toilets also (at hotel or office)? If you have symptoms only related to a particular toilet, is there anything specific about the toilet (closed, small toilet or mold/fungus in wall/roof of toilet)?

c. Is there a particular time when you have symptoms (like in morning only)? Or you have symptoms any time you go to toilet?

d. You have watering and sneezing. Do you have itching in nose? Do you have white/yellow thickish discharge? Is your nose congested?

e. Have you ever had running nose, sneezing, etc nose symptoms with seasonal changes, etc? Is there a particular season when you have more frequent symptoms? You have already mentioned about dust and food smells.

f. How is your digestion? Do you have constipation, slow digestion, hard stools, acidity, flatulence, etc?

g. Does anyone from your family have any type of allergy?

h. Do you smoke? Does anyone in your home smoke?

i. Please let me know how you treat yourself, which allergy tablets you have taken, how frequently, how effective they are, whether you have any side effects, etc.

Above details will help me to understand your symptoms better, to reach closer to diagnosis and to make better suggestions to you.

At present, I would like to make suggestions for you as follows:

1. For symptom relief, I would suggest my such patient an antihistamine (fexofenadine, loratadine, desloratadine or levocetirizine) plus montelukast as and when needed. Exact length of treatment depends upon the final diagnosis.

2. If symptoms are related to a particular toilet, I would suggest to improve ventilation and sunlight exposure to the toilet, which helps to remove irritant particles from the environment.

Please feel free to ask any further queries on follow up.

Wish you best of the health ahead.

Thank you & best regards,

Dr Parin N Parmar
Allergy-Immunology Consultant

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Brief Answer:
Antihistamine + Montelukast for 3 weeks, investigations for allergy

Detailed Answer:
Hello Mr XXXX,

Thank you for the follow-up.

Based on the details, I would make suggestions to my such patient as follows:

1. As you have nose symptoms triggered in all toilets, at all times, and also by other smells, the problem could be a mild inflammation in nose (rhinitis). In that case, all strong smells (of air freshners, toilet cleaners, food smells, perfumes, bad smells, etc) would act as irritants for nose mucosa and would not allow it to heal. This is not an allergy but an irritating effect.

So to control the inflammation, I would suggest my such patient to take a combination of an antihistamine (levocetirizine or fexofenadine) plus montelukast (many such combinations are available) regularly for 3 weeks.

After that, I would suggest my patient to stop medications and see whether the symptoms return. If there is return of symptoms, I would then suggest him a 2 week course of intranasal corticosteroid spray.

2. I would also like to see whether there is an underlying allergy. For that, I would suggest my patient to get a few blood tests as follows:

a. Serum total IgE
b. Phadiatop-Adult

Both these tests help to know about your allergy. Allergy is actually an immunological problem (hypersensitivity towards specific particles) and these are tests related to immunity.

3. I would also suggest my such patient to use nasal saline drops frequently (4-5 times daily) to improve nasal hygiene and to washout irritant particles.

4. If mental stress is an important factor in your life, I would also suggest you to adopt relaxation and stress reduction in life. As stress can worsen many allergies.

Hope above suggestions will be helpful to you.

Should you have any further query, please feel free to ask on follow-up. If you don't have further query, you can close the question and give your feedback.

Wish you best of the health ahead.

Thank you & best regards,

Dr Parin N Parmar
Allergy-Immunology Consultant

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