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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Allergies. Have had esophageal, bronchi tightening, congestion, have hypothyroidism. Done immunotherapy. Will I be okay?

ENT History- age 46 female, always had allergies in general as skin tests showed but nothing highly allergic just reactive, including three different rounds of testing and immunotherapy over 22 years but none in last 10 years, CT Scan 2 months ago showed no sinus infection and clear, - Yet- I have had esophageal and upper bronchi tightening- significantly. So much so doc concerned that it anxiety is part but not all of it. I am very sensitive to medication so I usually only take the smallest dose/even a pediatric dose.
Heart, Pulmonary Function all normal. I take12 hour Allegra-D every day, Omnarius/Zetonna puff once a day both sides, astrovent once a day - sometimes (membranes get too dry and then my congestion gets much worse and my ears stop up and I feel like I can't swallow in a normal rhythm plus salivary glands near ears feel like they are responding to something tart which makes them activate) I try not to use this drug unless there is simply no other option.
When severe congestion occurs, it is usually related to the tightening of esophagus and upper bronchi, warm sensations running from esophagus up through neck and into ears and now then nose stops up severely on both sides and it can last for hours. It is never in response to eating as these episodes happen in afternoon and late at night so that sleep is impacted. I have to get up and try to move around which helps just a little.
Many times, the migraine drug Axert reduces the "'swelling"' and congestion in my head which helps so much but that isn't a drug that can be taken often but I am wondering if the receptors it targets are playing a role in overreacting. I use simple saline sometimes but I worry about bacteria and getting an infection. I have hyperaldosterone and hypothroidism which have all been treated effectively for many many years.

My concerns are: (1) tell me the role of adrenaline or other significant stress hormones or other likely culprits and its/their possible influence on daily severe episodes of congestion (like a fight or flight thing only no identified association can be made) Are their treatments for this? It has been happening for about 3 years but has been much more frequent for the last two months- pretty much daily.
If this is vaso rhinitis (even with a few allergic components), what else can be done when these terrible episodes happen?
Thu, 6 Jun 2013
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General & Family Physician 's  Response
Welcome to HCM.The regular use of decongestant in Allegra-D will cause rebound congestion.It would be prudent to use Aegra/Fexofenadine alone.Use of Monteleukast(a leukotriene inhibitor) has a role to play in the presence of such symptoms.A thyroid check up to confirm correct levels of thyroid hormone.
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