Nose Blockage at night with Hypertension

44 yr old lady ,not a k/c/o DM/HT/Dyslipidemia c/o dyspnoea on exertion for the past 3 yrs along with 10% weight gain. On examination bilateral pitting pedal edema present more so on the right leg (photo attached) vitals are stable and all the systemic examinations normal. Also attaching the photo of her dry,coarse skin,mostly due to hypothyroidism P.s:Can pedal edema be severe enough to cause medial deviation of the toes??(photo attached) If not what are the reasons for it??

18y/o male c/o severe irritable dry cough continuously since 1week..no h/o of asthma,smoking,allergy.Vitals are spo2-93% a room air,bp 100/70,lungs clear,bae+ His investigation reports..kindly give me the relevant dDx, Rx and management further..

13yrs old boy with h/o recurrent nasal bleeding. h/o heat intolerance, since birth. spot diagnosis and kindly give opinion about management

A male child 10years old complaining about recurrent cough and cold after taking cold drinks or sudden change in environment. what should be the diagnosis

Friends today I am discussing about a common problem for sensitive persons known as Allergic rhinitis. What is allergic rhinitis? An allergen is an otherwise harmless substance that causes an allergic reaction. Allergic rhinitis, or hay fever, is an allergic response to specific allergens. Pollen is the most common allergen in seasonal allergic rhinitis. These are allergy symptoms that occur with the change of seasons. Nearly 8 percent of adults in the United States experience allergic rhinitis of some kind, according to the American Academy of Allergy, Asthma & Immunology (AAAAI). Between 10 and 30 percent of the worldwide population may also have allergic rhinitis. Symptoms of allergic rhinitis Common symptoms of allergic rhinitis include: sneezing a runny nose a stuffy nose an itchy nose coughing a sore or scratchy throat itchy eyes watery eyes dark circles under the eyes frequent headaches eczema-type symptoms, such as having extremely dry, itchy skin that can blister and weep hives excessive fatigue You’ll usually feel one or more of these symptoms immediately after coming into contact with an allergen. Some symptoms, such as recurrent headaches and fatigue, may only happen after long-term exposure to allergens. Fever isn’t a symptom of hay fever. Some people experience symptoms only rarely. This likely occurs when you’re exposed to allergens in large quantities. Other people experience symptoms all year long. Talk to your doctor about possible allergies if your symptoms last for more than a few weeks and don’t seem to be improving. What causes allergic rhinitis? When your body comes into contact with an allergen, it releases histamine, which is a natural chemical that defends your body from the allergen. This chemical can cause allergic rhinitis and its symptoms, including a runny nose, sneezing, and itchy eyes. In addition to tree pollen, other common allergens include: grass pollen dust mites animal dander, which is old skin cat saliva mold During certain times of the year, pollen can be especially problematic. Tree and flower pollens are more common in the spring. Grasses and weeds produce more pollen in the summer and fall. What are the types of allergic rhinitis The two types of allergic rhinitis are seasonal and perennial. Seasonal allergies usually occur during the spring and fall season and are typically in response to outdoor allergens like pollen. Perennial allergies can occur year round, or at any time during the year in response to indoor substances, like dust mites and pet dander. Risk factors for allergic rhinitis Allergies can affect anyone, but you’re more likely to develop allergic rhinitis if there is a history of allergies in your family. Having asthma or atopic eczema can also increase your risk of allergic rhinitis. Some external factors can trigger or worsen this condition, including: cigarette smoke chemicals cold temperatures humidity wind air pollution hairspray perfumes colognes wood smoke fumes How is allergic rhinitis diagnosed? If you have minor allergies, you’ll probably only need a physical exam. However, your doctor may perform certain tests to figure out the best treatment and prevention plan for you. A skin prick test is one of the most common. Your doctor places several substances onto your skin to see how your body reacts to each one. Usually, a small red bump appears if you’re allergic to a substance. A blood test, or radioallergosorbent test (RAST), is also common. The RAST measures the amount of immunoglobulin E antibodies to particular allergens in your blood. Treatments for allergic rhinitis You can treat your allergic rhinitis in several ways. These include medications, as well as home remedies and possibly alternative medicines. Talk to your doctor before trying any new treatment measure for allergic rhinitis. Antihistamines You can take antihistamines to treat allergies. They work by stopping your body from making histamine. Some popular over-the-counter (OTC) antihistamines include: fexofenadine (Allegra) diphenhydramine (Benadryl) desloratadine (Clarinex) loratadine (Claritin) levocetirizine (Xyzal) cetirizine (Zyrtec) Shop for OTC antihistamines. Talk to your doctor before starting a new medication. Make sure that a new allergy medication won’t interfere with other medications or medical conditions. Decongestants You can use decongestants over a short period, usually no longer than three days, to relieve a stuffy nose and sinus pressure. Using them for a longer time can cause a rebound effect, meaning once you stop your symptoms will actually get worse. Popular OTC decongestants include: oxymetazoline (Afrin nasal spray) pseudoephedrine (Sudafed) phenylephrine (Sudafed PE) cetirizine with pseudoephedrine (Zyrtec-D) If you have an abnormal heart rhythm, heart disease, history of stroke, anxiety, a sleep disorder, high blood pressure, or bladder issues, speak with your doctor before using a decongestant. Shop for decongestants. Eye drops and nasal sprays Eye drops and nasal sprays can help relieve itchiness and other allergy-related symptoms for a short time. However, depending on the product, you may need to avoid long-term use. Like decongestants, overusing certain eye drops and nose drops can also cause a rebound effect. Corticosteroids can help with inflammation and immune responses. These do not cause a rebound effect. Steroid nasal sprays are commonly recommended as a long-term, useful way to manage allergy symptoms. They are available both over the counter and by prescription. Talk to your doctor before starting a regimen of any allergy treatment to make sure you are taking the best medications for your symptoms. You doctor can also help you determine which products are made for short-term use and which are designed for long-term management. Immunotherapy Your doctor may recommend immunotherapy, or allergy shots, if you have severe allergies. You can use this treatment plan in conjunction with medications to control your symptoms. These shots decrease your immune response to particular allergens over time. They do require a long-term commitment to a treatment plan. An allergy shot regimen begins with a buildup phase. During this phase, you’ll go to your allergist for a shot one to three times per week for about three to six months to let your body get used to the allergen in the shot. During the maintenance phase, you will likely need to see your allergist for shots every two to four weeks over the course of three to five years. You may not notice a change until over a year after the maintenance phase begins. Once you reach this point, it’s possible that your allergy symptoms will fade or disappear altogether. Some people can experience severe allergic reactions to an allergen in their shot. Many allergists ask you to wait in the office for 30 to 45 minutes after a shot to ensure that you don’t have an intense or life-threatening response to it. Sublingual immunotherapy (SLIT) SLIT involves placing a tablet containing a mixture of several allergens under your tongue. It works similarly to allergy shots but without an injection. Currently, it is effective for treating rhinitis and asthma allergies caused by grass, tree pollen, cat dander, dust mites, and ragweed. You can take SLIT treatments, such as Oralair for certain grass allergies, at home after an initial consultation with your doctor. Your first dose of any SLIT will take place in your doctor’s office. Like allergy shots, the medication is taken frequently over a period of time determined by your doctor. Possible side effects include itching in the mouth or ear and throat irritation. In rare cases, SLIT treatments can cause anaphylaxis. Talk to your doctor about SLIT to see if your allergies will respond to this treatment. Your doctor will need to direct your treatment with this method. Home remedies Home remedies will depend on your allergens. If you have seasonal or pollen allergies, you can try using an air conditioner instead of opening your windows. If possible, add a filter designed for allergies. Using a dehumidifier or a high-efficiency particulate air (HEPA) filter can help you control your allergies while indoors. If you’re allergic to dust mites, wash your sheets and blankets in hot water that’s above 130°F (54.4°C). Adding a HEPA filter to your vacuum and vacuuming weekly may also help. Limiting carpet in your home can also be useful. Alternative and complementary medicine Due to concerns over possible side effects, more people with allergies are looking at ways to address hay fever symptoms “naturally.” However, it is important to remember that any medication can have side effects, even if it’s considered natural. Aside from home remedies, options can also include alternative and complimentary medicine. The downside to these treatments can be that there’s little supporting evidence to prove that they’re safe or effective. The correct dosing may also be difficult to determine or achieve. acupuncture nasal saline irrigation butterbur supplements honey (choose raw, organic varieties) probiotics Although these alternative treatments are derived from plants and other natural substances, they can possibly interact with medications, as well as cause reactions. Try these with caution, and ask your doctor before use. Complications of allergic rhinitis Unfortunately, allergic rhinitis itself can’t be prevented. Treatment and management are keys to achieving a good quality of life with allergies. Some complications that can arise from hay fever include: inability to sleep from symptoms keeping you up at night development or worsening of asthma symptoms frequent ear infections sinusitis or frequent sinus infections absences from school or work because of reduced productivity frequent headaches Complications can also arise from antihistamine side effects. Most commonly, drowsiness can occur. Other side effects include headache, anxiety, and insomnia. In rare cases, antihistamines can cause gastrointestinal, urinary, and circulatory effects. Allergic rhinitis in children Children can develop allergic rhinitis too, and it typically appears before the age of 10. If you notice that your child develops cold-like symptoms at the same time each year, they probably have seasonal allergic rhinitis. The symptoms in children are similar to those in adults. Children usually develop watery, bloodshot eyes, which is called allergic conjunctivitis. If you notice wheezing or shortness of breath in addition to other symptoms, your child may have also developed asthma. If you believe your child has allergies, see your doctor. It’s important to receive the correct diagnosis and treatment. If your child does have significant seasonal allergies, limit your child’s exposure to allergens by keeping them inside when pollen counts are high. Washing their clothes and sheets frequently during allergy season and vacuuming regularly may also be useful. Many different treatments are available to help your child’s allergies. However, some medications can cause side effects, even in small doses. Always talk to your doctor before treating your child with any over-the-counter allergy medication. Outlook The outcome of treatment depends on your condition. Seasonal allergic rhinitis usually isn’t severe, and you can manage it well with medications. However, severe forms of this condition will likely require long-term treatment. Preventing allergies The best way to prevent allergy symptoms is to manage your allergies before your body has a chance to respond to substances adversely. Consider the following preventive measures for the particular allergens you’re sensitive to: Pollen The AAAAI recommends starting medications before seasonal allergy attacks. For example, if you’re sensitive to tree pollen in the spring, you may want to start taking antihistamines before an allergic reaction has the chance to occur. Stay indoors during peak pollen hours, and take a shower immediately after being outside. You’ll also want to keep your windows closed during allergy season and avoid line-drying any laundry. Dust mites To reduce dust mite exposure, you can take measures to make sure your home is not a friendly environment for dust mite development. Wet mop hard floors, rather than sweeping. If you have carpet, use a vacuum with a HEPA filter. You’ll also want to dust hard surfaces often, and wash your bedding weekly in hot water. Use allergen-blocking pillows and cases to decrease dust mite exposure while you’re sleeping. Pet dander Ideally, you’ll want to limit exposure to any animals that you’re allergic to. If this isn’t possible, make sure you clean all surfaces often. Wash your hands immediately after touching pets, and make sure your furry friends stay off your bed. You’ll also want to wash your clothes after visiting homes that have pets. Tips to prevent allergies Stay indoors when pollen counts are high. Avoid exercising outdoors early in the morning. Take showers immediately after being outside. Keep your windows and doors shut as frequently as possible during allergy season. Keep your mouth and nose covered while performing yard work. Try not to rake leaves or mow the lawn. Bathe your dog at least twice per week to minimize dander. Remove carpeting from your bedroom if you’re concerned about dust mites. HOMEOPATHIC MEDICINES FOR ALLERGY Arsenic alb - There is thin watery discharge from the nose with burning sensation, recurrent sneezing one after another with runny nose. Burning and tearing of eyes . There is puffiness around eyes, stuffy nose. The person has an asthmatic tendency with breathing difficulties, and oppression of chest which is generally worse when he lies down. On sitting with a forward bending posture makes the patient little comfort from his asthmatic problem. There is marked wheezing sound during asthmatic affection. The asthma is worse in wet cold weather. Besides that the constitutional symptoms of arsenic alb are anxiety, restlessness, prostration, burning sensation. The anxiety that is found in Arsenic alb is intermingled with fear. The other prominent symptoms are debility, exhaustion, restlessness, with nightly aggravation. Great exhaustion after a slightest exertion. Sulphur – There is itching with redness of eyes in allergic condition. The itching is followed by burning sensation and relieved by cold application. sulphur patient is always irritable, depressed, thin and weak, but good vappetite. He is having forgetful nature, difficulties in thinking. He has many good ideas but cannot implement it. Selfish type person, no regards for others. very lazy person, not cleanness, never look after about his dressing and clothing. Don’t like to take bath. Having of skin diseases always. The skin rashes itch a lot generally in night and warm atmosphere. The person has a feeling congestion or oppression of chest in asthmatic condition. Natrum mur – Natrum mur is generally well indicated in case of allergic condition which gives the symptoms of more itching of nose, throat, ear with recurrent sneezing one after another. The characteristic discharge from the mucous membranes is watery or thick whitish, like the white of an egg. Natrum mur patient is very sensitive in nature. Every thing he/she takes into the heart. The person is irritable in nature and when in upset does not like any body’s present or giving of any consolation. Consolation aggravated the state of the mind - the melancholy, the tearfulness, sometimes brings on anger. The Natrum mur patient is extremely emotional. The whole nervous economy is in a state of fret (visible anxious like scratching finger on her skin in worry). Completely or desperately in love brings on complaints. The natrum mur patient desire to take extra salt in his diet. Sabadilla- it has good action on mucous membrane of the nose and the lachrymal glands, producing coryza and symptoms like hay-fever. There is spasmodic sneezing one after another. symptoms of hay-fever or allergic rhinitis with itchy nose and fluent coryza. Either nostril stuffed up, inspiration through nose labored, snoring. Violent sneezing is occurred from time to time, shaking abdomen followed by lachrymation. There is runny nose with severe frontal headache and redness of eyelids. Allium cepa: Allium Cepa is one of the most commonly used Homeopathic medicines for Allergic Rhinitis or Hay Fever. It is generally used in the symptoms of severe runny nose that drips from the tip of nose with watery eyes. There is burning of nose due to over secretion mucous. Along with the watery nasal discharge there is watery eye. There is profuse sneezing associated with runny nose and watery eyes. Tuberculinum- The patient is very susceptible to catch cold. The physical constitution is lean and thin like natrum mur, but not obese like calcarea carb. If there is family history of tuberculosis or bronchial asthma then is more suitable to give this medicines in any allergic or asthma condition. The person is very depressed, melancholic, taciturn sulky nature.