I’m having constant sneezing fits which, as a teacher, is both inconvenient and embarrassing. I have had tests for allergies which all came back clear. Is there anything that could at least curb the sneezing?
Charlotte Topping, Wigan.
Dr Martin Scurr replies: For many years I worked in the nose clinic at a London hospital, where patients with persistent nasal symptoms such as a blocked or streaming nose would be referred.
They would be given an allergy test, and in 90 per cent of cases this would show their problems were indeed due to some form of allergy – from various pollens and animal dander (cat/dog, various birds) to house dust mites.
What was interesting was that even in those who didn’t test positive for an allergy, giving them an allergy suppressant medication (such as antihistamines) reduced the symptoms.
On this basis, I would suggest trying the same strategy. First thing every day, use a salt water flush to clear out any potential allergen in your nasal passages.
To make the flush, mix a teaspoon of table salt in half a pint of boiled water in a clean container and keep this in the fridge (it will keep quite well for days).
When it is fully cooled, put a tablespoonful of this in the palm of the hand and inhale this up each nostril in turn while leaning over a wash basin. Repeat this two or three times.
Dr Martin Scurr advises flushing your nasal passages with salt water first thing every day if you might be suffering from allergies
In addition, try taking the antihistamine fexofenadine – the 120mg tablets do not require a prescription – once or twice a day.
Trial these two approaches together for a month and keep a diary of your sneezing: I am very hopeful that your symptoms will be reduced at least.
I am 82 and in great pain from arthritis in my neck. I’ve tried steroid injections, as well as tramadol, amitriptyline and pregabalin. But I’m still in agony and the medications have horrible side-effects. I’m at my wits’ end.
Andrew Ford, Northants.
Dr Martin Scurr replies: I feel for you – this is a miserable affliction that affects the facet joints which connect the bones of the spine (the vertebrae).
This is a condition of getting older and by middle age most people have a degree of arthritis in these small but critical joints.
Even in patients who did not test positive for an allergy, Dr Scurr noted that giving them an allergy suppressant medication (such as antihistamines) reduced the symptoms
The treatment options are limited. Most patients are expected to make do with non-steroidal anti-inflammatory drugs (such as ibuprofen), but these can lead to side-effects, such as gastric irritation.
Many patients try physiotherapy, osteopathy and massage with varying degrees of success.
Steroid injections, which dampen down inflammation, can provide short-lived relief; treatment with the strong and potentially addictive painkiller tramadol is undesirable for anything other than the short term.
In your longer letter you say the pain disrupts your sleep and the medication caused constipation, so your GP switched you to pregabalin – which works by blocking pain signals travelling through the nerves.
You say it hasn’t helped yet, but that may be because the dose has to be gradually built up to 300mg or more and it can take at least a month for the pain-relieving effects to be noticed. I’ve known patients require up to 1,800mg daily.
If your doctor is unwilling or unable to supervise this, I’d suggest asking to be referred to a specialist at a pain clinic.
You also mention having had a new technique, called radiofrequency denervation, where the nerve fibres in the facet joints are destroyed by heat to block pain signals reaching the brain.
It’s minimally invasive and trials suggest it has a success rate of between 43 and 80 per cent after one year.
Although it failed for you, it might be worth having the procedure again.
In denervation it is essential that the treatment targets the facet joints causing the pain.
There are seven vertebrae in the neck and each one has four facet joints so it may be that not all were targeted in the first treatment session.
My view is you should be seen again by the specialist who did it first time and a further procedure considered. Good luck.
