Rhinitis or sinusitis

[Daniel]

Hey @Kkol ,

First off, you’re doing a great job pushing for answers and getting the right specialists involved. A dry cough plus years of post-nasal drip is exhausting for a kid (and a parent), and your note shows you’re thinking exactly like a great advocate.

Seeing what the immunologist is doing, I’ll first try to explain what he is probably doing. Then I’ll give you a clear, step-by-step plan you can follow alongside your immunologist:

What the doctor is testing:

• Is the nose the driver? (Rhinitis vs sinusitis)
  Daily saline clears mucus and lets the steroid nasal spray reach the lining. If cough and drip ease within 1–2 weeks, nose inflammation is the likely driver (rhinitis). If there’s persistent facial pressure, thick colored mucus, and smell loss, sinusitis stays on the table.

• Is it allergy or not?
  Cetirizine (Zyrtec) blocks histamine. If symptoms improve on it, that supports an allergic component. If not, non-allergic triggers (irritants, cold air, infections, reflux) are more likely. The skin test will map which allergens matter.

• Is there a lower-airway piece (cough-variant asthma)?
  If the cough lingers, your doctor may add a brief inhaled steroid trial or do spirometry/FeNO. Improvement points toward airway hyper-reactivity.

What to do the next 4-8 weeks:

Often, with true post nasal drip, dairy products can worsen symptoms. I often recommend my clients to remove dairy products and see what happens. However, it seems there is some uncertainty about what your son is really suffering from. Therefore, a wider scope of interventions could help you find out what is at play:

• Tighten the bedroom environment (can be a big win).
  Make the bedroom the cleanest air in the house. Vacuum with a HEPA machine if you have one. If you don’t have one, dust with a slightly damp microfiber cloth so dust sticks to the cloth. Mop hard floors with water, and beat rugs outside, then let them sit in the sun for an hour. Use pillow and mattress dust-mite encasings if you have. Wash bedding at 60 °C every week. Keep humidity between 40 and 50 percent with a simple hygrometer. Do not let it climb higher, because mold and dust mites thrive in high humidity. If humidity is higher, mold could sure be a player and I recommend you to take a look at the course we provide here! Reduce clutter and open shelving so less dust accumulates. Keep pets out of the bedroom at all times. Avoid fragrances, candles, incense, and aerosols. If budget allows later, add a room HEPA air purifier for the bedroom; it often helps more than upgrading the vacuum.
• Protect the throat and calm reflux habits.
  Sometimes reflux can cause post-nasal drip. In this case, it is more likely that the next interventions will work: Eat dinner earlier and keep evening portions smaller. Elevate the head of the bed by 10–15 cm. Offer warm fluids. If your child is older than one year, a teaspoon of honey at bedtime can soothe a dry cough.
• Check the lungs if the caugh lingers:
  If the cough remains, ask for spirometry or a FeNO test to screen for cough-variant asthma. If asthma is at play, let us know, and we could advise you further. If you like to see what interventions you could think of, take a look at this handout.

You’re on the right track. Give this plan a clean 4–8-week run, then let the skin test and response guide next steps. You’ve got this!

• This reply was modified 1 week, 3 days ago by  Daniel.

[Kkol]

Thank you Daniel for this thorough reply. My son is 23. So using steroid nasal spray for short period with zertec and the saline nasal spray is ok? Or better to use separately to know if it’s rhinitis or allergy?

Thank you

[Daniel]

’m missing key background (what’s already been tried, how severe his symptoms are, and how they affect his days), so I can’t judge treatment choices for him. I can only try to explain from the meds what your doctor might be thinking. A good response to cetirizine is a clue that histamine is involved, but in conventional medicine it is not proof of allergy. Allergy is diagnosed by history plus testing. For skin testing, antihistamines usually need to be stopped for 5–7 days beforehand

• This reply was modified 1 week, 2 days ago by  Daniel.

[Kkol]

Post nasal drip since couple of years and this dry cough lately maybe a year ago. He use to smoke mainly ikos but he stopped two months ago. No other issues. He use to have nausea every morning and he was first study case of B here in forum. Nausea every morning for like 5 years and now it’s still in background but not as use to be. Many tests where done and only elastase was a bit low and he had creon for a month and retest and elastase came back normal.

• This reply was modified 1 week, 2 days ago by  Kkol.

[Kkol]

And what about natural treatment of its environment allergy? The de mentioned immunotherapy. Not sure if this is good.

Quercetin and stinging nettles won’t tray the issue. Right?

[Daniel]

When the trigger is an environmental allergen (dust-mite, pollen, cat, mold), the functional-medicine goal is twofold: calm the whole system now, and retrain tolerance long-term if we can. Here’s how I’d explain it to a client.

First, natural relief that actually helps: make the bedroom the cleanest air in the house. Think HEPA air filter, dust-mite covers on pillow and mattress, bedding washed hot once a week, damp-dusting, pets out of the bedroom, good ventilation, dehumidifier if the room feels damp(see my earlier reply). Do a simple nasal routine: isotonic saline rinse morning and night. These two steps alone often drop symptoms fast because you’re lowering the “histamine bucket” where you sleep.

Food can push that same bucket up or down. Try a short low-histamine check for 10–14 days: fresh-cooked proteins, same-day carbs, lots of simple veg and olive oil, pause alcohol and the big histamine hitters like aged/fermented foods and long-kept leftovers. It’s not forever, just a reset while you see what changes.

Where do quercetin and stinging nettle fit? They’re like good fire extinguishers: they soothe mast cells and histamine signaling and can make you feel better, but they don’t retrain the immune system’s memory of “cat = danger.” So you’re right: they don’t fix the root by themselves. They’re tools for symptom control while you work the plan. If used, I tell clients to start one at a time, low and slow, follow the label, and check meds first. Quercetin has benefits above antihistamines: they dont make you feel foggy and tired, but quercetin can interact with some antibiotics and blood thinners; paired with bromelain quercetin gets absorbed better, but avoid bromelain if there’s a pineapple allergy or you’re on strong anticoagulants. If someone flares with fermented foods or restaurant meals, a DAO enzyme before those meals can be helpful as a temporary crutch; note that many DAO products are porcine-derived.

Gut and immune “terrain” still matter even for an environmental allergy, because a leaky, irritated gut or poor sleep/stress rhythm keeps mast cells jumpy. I often layer in gentle gut supports (enzymes if meals sit heavy; zinc-carnosine or DGL if there’s reflux/upper GI irritation; glutamine if someone tolerates it), plus an omega-3, vitamin D to the person’s sweet spot, and a histamine-friendly probiotic profile (seeking health has good ines). Go slowly if there’s SIBO history. All terrain work should be personalized and started one change at a time.

Now, immunotherapy. My stance: if testing clearly shows a single or few meaningful environmental triggers and symptoms actually match real-life exposure, allergen immunotherapy (shots or sublingual) is one of the few disease-modifying options we have. It teaches tolerance; it’s not just a band-aid. It is a commitment over years and only works when the target is right, and it doesn’t replace the terrain work above. Safety is generally good with proper oversight. So, I like to lower total load for a few weeks, run targeted IgE testing if that hasn’t been done, and if “dust-mite” or “grass” lights up and the story fits, add immunotherapy for long-term retraining while you keep the environment and habits clean.

If I turn this into a simple starter plan for a client with an unknown environmental allergy, it looks like this: two weeks of bedroom reset + nasal care + low-histamine food reset, track symptoms daily from 1–10; keep anything that clearly helps. Add one calm-the-bucket tool at a time if needed (vitamin C, quercetin, nettle, DAO for “risky” meals), checking interactions first. In weeks 3–6, support gut lining if digestive flags exist and tidy sleep, stress, and movement. Then do targeted allergy testing guided by the story. If a major trigger is confirmed and life is still limited by symptoms, have a real conversation about shots vs drops, and decide based on convenience, safety, and preference.

Bottom line: yes to immune terrain and histamine-load reduction now, yes to immunotherapy when a clear allergen is identified and symptoms matter, and no, quercetin/nettle don’t “retrain” the immune system, they buy you comfort while you build tolerance and precision

[Daniel]

Hey @kkol,

One more thing that comes to mind if you live in the UAE: Damp indoor air keeps the nasal lining inflamed, thickens mucus, and feeds dust mites and mold. Even without a positive “mold allergy,” mold fragments and gases can be of influence and drive post-nasal drip and cough.

Start by measuring, not guessing. Put an inexpensive hygrometer in the bedroom and living area and aim for 40–50% most of the day. Anything consistently above ~50% is a problem. Use the AC to dehumidify (Dry/Dehumidify mode if available), keep windows closed on humid days, and set the fan to Auto so coils actually remove moisture. Service the unit: replace filters on schedule, clean evaporator coils, and clear the condensate drain. If you still can’t hold 40–50%, add a bedroom dehumidifier, vent bathrooms and kitchen during use and for 20 minutes after, fix leaks promptly, and avoid drying laundry indoors.

Check the common hiding spots for mold: the AC closet and drip pan, around windows and sills, under sinks, shower grout and curtains, behind furniture on exterior walls, inside wardrobes and shoe cabinets. A musty smell is a clue. If growth is widespread, recurrent, or dark/black on porous materials like drywall, bring in a qualified expert and don’t clean/remove yourself: expert advice matters here.

Lower exposure elsewhere too. Run a room HEPA purifier in the bedroom and keep fabrics and clutter to a minimum. For foodborne molds and aflatoxins, buy nuts, peanuts, pistachios, corn, and spices from reputable brands, use smaller packages, store them sealed in the fridge or freezer, keep the pantry cool and dry, and discard anything that smells musty or tastes bitter.

Mold and humidity are easy to overlook because they’re invisible and skin tests can be negative while the nose is still irritated. A simple two-week log of morning and evening humidity alongside symptoms often makes the link obvious. You’re doing smart detective work. share what you find and we’ll fine-tune.

I wish i had a easier and shorter answer to your question!