Feel lost and not sure how to follow up with my PCP (& ENT)

My PCP said it's allergy (allergic rhinitis) but I feel like it's more than that.

**********

Family history: My sister & dad have rhinitis. My mom has chronic cough and her PCP said it’s allergic (don't have detail check-up). I had strong allergic reaction to Erythromycin (whole body & face swollen & covered by hives/rash) when I was a kid

Since 2010, I started feeling congested at night (bedtime & early morning) and okay in daytime. Occasionally took Claritin because of tickle in throat but nothing serious. Normal daily life & sleeping is fine.

Things starts changing in 2013-2014.

Oct 2013 when I was 30, me & my husband moved from Culver City CA (Los Angeles) to Carson CA (South Bay).

Jan 2014, I had flu for 2 weeks (101F fever + cold symptoms). In Feb, my PCP started prescribing Flonase (50 mcg 2 sprays per day) as I had really bad congestion, tickle & cough did not go away. In Apr, started feeling chest tight & had disturbed sleep on and off for 2 weeks. PCP prescribed Albuterol and gave me relief. I did chest x-ray, lung function test (carbon monoxide diffusing capacity + spirometry before & after bronchodilator), blood test and nothing is abnormal. Coughing is on and off. In Jun, visited urgent care as had really coughing fit at night & couldn’t sleep (used 6-8 puffs per week).

Urgent care doc gave me a trial of Singulair (10 mcg for 3-month) + spacer and started feel less cough, chest tight (now use 2-4 puffs per month) and tickle, but still feel a bit congested. In Aug, my PCP referred me to ENT and suggested to add Astelin for treating me persistent rhinitis. I did an allergy blood test for 13 kinds of environmental allergen but it’s negative.

Later, I was asked by a nurse to get not only the flu shot and also a pneumococcal shot. I did get those shots when I went for another visit.

**********

I did ask my PCP if I am having asthma. She said it’s only an allergy/ allergic rhinitis.

However, she said I need to keep taking/refilling Flonase & Singulair for long-term, and keep my Albuterol handy. My PCP said I can use the inhaler if I cough a lot at night, feeling short of breathe or wheezing.

How should I follow up with my PCP &/or ENT? I feel a bit better when the weather is warm/hot, but easy to start coughing when it’s cold, temp change, dusty room or laughing hard.

Any suggestion will be greatly appreciated!
Thanks

Hi kazbern,

Thanks for your reply!!

Maybe you are right. I shouldn’t take too serious about the cause behind as it seems the current treatment makes things under control at this point…but not sure what will happen during fall and winter. Wish I can survive LOL

Feel sorry for my husband as he gets a bit nervous when I start coughing, esp at night when I’m lying on bed. Few flare-ups were happened before around bedtime and had to take my puffer. Right now I try to write a brief journal for any question that I can email and ask my PCP.


**********

Actually my PCP did suggest me to do saline sinus lavage and am now using my neti pot every night, close to (or after) dinner time. After the neti pot, I use Flonase and take singulair before bedtime. Feels good but cannot eliminate the congestion.

Not sure if I have GERD as I haven’t got check-up for that, but pretty sure I’ve post-nasal drip as both of my PCP and urgent care doc have made the same comment (esp. when I have flare-up and the urgent care doc said it’s really bad after examining my throat). Although the allergy blood test turns negative, my ENT said it can be non-allergic rhinitis or mixed. So he suggested adding the Astelin and see if it can solve the congestion (1 or both sides at night, occasionally in day time)

I’ve heard that singulair might have mental side effect. For me, it seems okay for the past 4 months except occasional, mild GI upset. At least I feel fewer symptoms (tickle, cough, and chest tight).

I do think that I may have cough variant asthma as the urgent care doc has mentioned that before. However, my PCP doesn’t think it’s asthma (coz I’m not wheezing…) at this point so I am not sure if she will start any alternative treatment/trial…except using my puffer as need.

So far it seems things are under controlled. If I have problem during fall & winter, maybe I will consult my PCP or try the Astelin.

allergy tests should be done by skin testing not blood for the best results I think.

And I have never, ever wheezed in my life except for the year I got diagnosed. I'd been coughing each spring for a couple of years at that point. One night I woke up feeling like someone was sitting on my chest. That's how I got diagnosed. Since then, I'm like Razzle, I just cough. A lot if I'm not in control of my asthma.

Hi @Trotters, @kazbern, @Razzle~

Thanks for all your comments :D

My ENT preferred blood test for allergen due to my ongoing allergy meds, including Flonase, Singulair and (sometimes) Claritin. The skin test would be interrupted by my current treatment so he chose the blood test. I may ask my ENT whether I need to do additional allergy test when I have a chance (I asked my PCP before but she said it's hard to avoid allergen in real life...meds control is more effective... :P)

My ENT did a Nasal Endoscopy and said my nasal congestion and post-nasal drip caused by rhinitis (either allergic, non-allergic or mixed). I may ask about whether the sinus fungal infection is make sense to him ;)

At this point, seems like my symptoms are controlled compared to 3-months ago, only a mild chest tight (daily neti pot, 1 spray Flonase, 1 tablet Singulair at bedtime, Albuterol as need). If I feel the change of status or symptom in fall and winter, will definitely bring up the GRED and report the use of med.

Will keep you posted if there is any question or you have comment
:)

Janiz