Dry weather is back! Managing nosebleeds

With the monsoon being over dry weather has set in. In India the Indian summer has set in, cold at night, hot dry weather in the mornings. The difference in temperature, especially while moving from the heat into an airconditioned room can trigger a nosebleed. Nosebleed happens because of the following reasons.

  • Dry weather leads to dryness of the inner lining of the vestibule or entrance of the nose. The blood vessels on the septum or central part of the nose is known as Little’s area get congested and they burst which leads to bleeding. Later on the blood clots forming a scab which is tempting to pick. On picking this scab the bleeding will start again.
  • In case of small children there could be a chance that they have put a foreign body up their nose.
  • Due to accidental injury to the nose
  • Due to Sinus infections or a tumor or polyp in the nose

How to manage a nosebleed:

Don’t get alarmed. Simple nosebleeds can be managed easily.

  • First of all sit down in a well ventilated area and bend forward so that the blood falls straight and not down the back of the throat which can cause choking. This reduces blood pressure which aids in stopping the bleeding. Don’t lie down.
  • loosen tight and constrictive clothing
  • Don’t attempt to stuff cotton in the nose or try to wipe it with any object. This will only scratch the delicate tissues inside the nose and cause more bleeding
  • pinch the tip of the nose with thumb and forefinger and breath through the mouth
  • apply ice packs to the cheeks and face.

Attend the emergency room if

  • The bleeding is too much or has been going on from the next 20 minutes
  • Small children
  • Anemic people
  • In case the bleeding is due to accident or injury
  • If the patient has difficulty breathing

For long term management and prevention of nose bleeds:

  • Avoid sudden extreme temperature changes
  • apply oil or petroleum jelly in your nose twice or thrice daily. This keeps the area moist and stops crusting and bleeding
  • in case of blood or pus discharge from the nose, especially a single nostril in children, chances of sticking something up the nose are high. In adults it could be due to sinus disease
  • If the bleeding is severe and more frequent, check with your doctor
  • Keep fingernails short with small children

The information above is solely the views of the author. Please consult your ENT specialist for treatment


So it’s world allergy week. As per the World Allergy Organisation the theme is

Allergy care does not stop with COVID 19.

So in the ongoing pandemic, if you have allergies, asthma, do not hesitate to reach out to your Allergy specialist. And keep in mind other monsoon diseases too

Pollen allergies in warm countries like India

Pollen allergy is fairly common in India. No, not maple, oak or birch. These plants are not found in the plains of India, yet they are included in the allergy testing panel of major blood allergy tests.

Pollen allergies can cause asthma, allergic rhinitis, allergic conjunctivitis, skin rashes and other manifestation of allergy.

common symptoms are sneezing, itching, dark circles under the eyes (allergic shiners), allergic salute(persistent rubbing of the nose to push it up, most common in children, and conjunctivitis.

This is known as Pollinosis

So which plants fairly commonly cause allergies in India?

A lot of flowering plants grow in the tropical climate of India. Some plants which flower throughout the year spread pollen all the year round. They are known as perennial plants. They can cause allergy throughout the year. Most of the grasses, mustard, castor oil, papaya tree , mesquite and weeds like parthenium, amaranthus and chenopodium shed pollen throughout the year.

While plants like mango tree and a few other plants flower in specific seasons

However as per the Aria guidelines allergies are no longer classified into seasonal or perennial. They are known as persistent or intermmitent, mild, moderate or severe depending on the duration.

Common Allergy seasons are January to June, when most flowering plants shed pollen. and post monsoon till Novemberwhen tnere is a spurt in grass and weeds.

Global warming has lead to increased pollen allergy due to increased summer and warm climate favouring flowering of grasses and other trees.

What are weeds? weeds are small plants which are not planted deliberately. Their seeds are carried on the wind. They grow on the side of the road or in vacant lots like below

So a lot of people believe that pollen allergy is a thing of open grasslands and villages, not the cities. Wrong. A lot of wild plants and weeds which grow at the sides of gutters and the road fairly can cause allergy.

Pollen from grass and some trees is very small and is carried by the wind from one plant to the other. Some pollen can travel for hundreds of kilometres , mixing with the dust in the cities .Pollutants like smoke, petrol and diesel fumes in the air can worsen your allergies.

Following plants cause allergy throughout the year:

Plants like Doob grass or bermuda grass, the common Durva grass which is used for the pooja of Lord Ganesha. It is commonly used as a lawn grass. It is a major course of allergy

Durva Grass - Rudraksha Ratna

Congress grass or Parthenium. It is a common weed and grows at the side of the road, in grassland and vacant lots.

Neem tree

Amaranthus and Chenopodum are found in the same way.

Agreratum Conyzoides or Nilam, Xanthium or cockleburr.

Common Cocklebur, Xanthium strumarium, San Diego, California - YouTube

Brassica nigra or sarson, mustard plants

Seedeo Black Mustard Brassica Nigra) 200 Seeds: Amazon.co.uk ...

Papaya tree, castor oil tree and coconut trees are fairly common all over india

Another common tree is the raintree. It is found in all major cities of India

Mango trees can cause allergy. They are seasonal plants from March to April

Papdi or Holoptelia

Medicinal Plants: Holoptelea integrifolia, chirivilva, Nali, aya

Prosopis or mesquite trees, commonly known as vilayati bavad, Pahadi Kikar,is a fairly common plant found at the edge of open grasslands on the outskirts of cities.

Ipomoea or Morning glory

Ipomoea Tricolor: Growing Great Grannyvines | Epic Gardening


File:Putranjiva roxburghii - Putranjiva at Kolkatta - IRCTC 2017 ...

Typha Augusta

Typha angustifolia Small Reed Mace, Narrowleaf cattail PFAF Plant ...

Prevention of pollen allergy in Cities:

  • Pollen dispersion is more in early morning and late evening. Avoid going outside during that time.
  • Avoid morning walks in Pollen season.
  • Wear a mask or cover your face while outside. Wear full sleeve clothes
  • Take a shower on reaching home immediately and put your clothes to wash to remove pollen particles stuck to it.
  • Wash your hair often
  • Encourage planting of trees which are non invasive and known to be non allergic
  • symptomatic medication as prescribed by your doctor
  • Allergy testing for pollen
  • Allergy vaccines or allergen specific immunotherapy. This is a natural , safe and long term treatment for allergies. More details are available on the post


Managing allergies during the lockdown: If you have dust mite allergy refrain from vigorous house cleaning.

So, all of us are aware that the world is in the grip of a pandemic. A lot of us suffer from allergies too. This article is not to give any advice on Covid 19 or its treatment. I stress that you follow the WHO guidelines on social distancing, hand washing, personal hygeine and stay at home. In case of fever, or any suspicious symptoms please consult your local health centre immediately.


  • It goes without saying that asthmatic patients are at high risk of complications. It is stressed that they should stay at home, refrain from working even if they are in the essential category. They should keep reserve medicine ready such as inhalers and asthmatic medication as prescribed by their doctors and have emergency medication handy.
  • Since you’re staying at home its good for some people. Environmental pollution levels are on an all time low, and the air is fresher and cleaner to breathe.
  • Pollen exposure is low since you are going out often. Some people have isolated woodland area near them and are going for walks there. However, you should be careful about pollen exposure in such cases and if there are trees near you which trigger your hay fever, best avoid walking outside
  • Wear a mask at all times.

The hitch is household allergens: the biggest ones are house dust mites. A lot of people are taking advantage of the lockdown time and cleaning their houses, but in people with dust mite allergy this could be more of a curse than a blessing.

Your regular household helps may not be available to clean your house so refrain from over enthusiastic cleaning. Ask some other family member to do it instead. However, if the task is on you,

  • Cover your face properly before dusting
  • Prefer vacuuming and wet mopping over dusting
  • Dry your bedsheets, blankets, pillowcases in the sun and wash them weekly
  • Air your mattresses and pillows and vacuum them properly


They could trigger your allergies.Safer to stay at home than visit public places

On the other hand the rough hand sanitizer and soap could trigger skin allergies to chemicals, contact dermatitis and peeling of skin. Be judicious in your use of these chemicals and use plenty of moisturizer, petroleum jelly or plain coconut oil to keep your hands soft.

Managing food allergies :

So now everyone is at home there is the temptation to create and try out new recipes.


  • It’s an advantage in case you have a food allergy. You can prepare foods which suit you.
  • On the other hand, one must be careful about food, if unknown to you something could have been added to the food which can give you a bad allergic reaction
  • On the other hand you could be tempted to try out something which does not agree with you.
  • In any case keep you epipen handy. And contact your doctor immediately

The views are solely of the author. please contact your local health care workers for any emergency

Snoring and Sleep Apnea

Don’t take snoring lightly! It can be the sign of an underlying serious disease!

Why do we snore?

  • Snoring is the loud sound produced by a person while sleeping.
  • It is caused when the air passage vibrates: this includes the palate, the uvula, the walls of the throat and the back of the tongue, as the tissues relax and become loose during sleep
  • One more reason is if there is turbulence in the nasal passages when air passes through them due to septal deviation, polyps, congestion of the nose from allergies, sinus disease, etc,
  • Enlarged Tonsils and adenoids are a major cause of snoring and mouth breathing in children
  • It can be loud enough to create a nuisance in public places and transport, disturb the sleep of the spouse and partner. It can be embarrassing for the snorer.
  • Snoring should be taken seriously. It is not healthy, neither is it funny. It could be the sign of a serious disease!
  • Sleep apnea increases the risk of high blood pressure, diabetes, weight gain
  • Silent heart attacks can occur early in the morning due to sleep apnea

Sleep Apnea

What do you mean by Sleep Apnea?

  • Apnea means a sudden stoppage of breathing
  • During sleep the airway collapses and shuts down completely as above. At this point the breathing stops. This is known as sleep apnea.
  • After a few seconds the brain realizes that the oxygen levels are falling and it sends signals to the chest and abdomen to start moving to force the airway open. This produces a sudden snorting sound and the patient is awakened. However the patient may not be aware of this.
  • If this happens more than 5 times in an hour at night it is not healthy.
  • It hampers normal sleep cycle and the patient does not get proper 3 levels of sleep or REM sleep

How do we diagnosis sleep Apnea?

Proper History taking

  • The symptoms of sleep apnea are not feeling fresh on waking up, dryness of mouth, headache
  • Sleepiness during the day. Some patients can fall asleep suddenly while driving, reading, sitting comfortably, watching television. This can be dangerous
  • Lack of alertness determined by special tests
  • Frequent visits to the toilet at night
  • Weight gain in spite of following weight loss measures. This is a vicious cycle. Sleep apnea makes losing weight difficult. Being overweight makes belly fat more and tissues in the mouth loose which worsens the condition.

Polysomnography or sleep study

This is a study of changes occuring in the body during sleep

  • It can be done at home. Various channels are attached to the body as above, and recording is done of changes in the body during sleep overnight
  • It is simple and does not restrict sleep position or regular bedtime habits

Drug induced sleep endoscopy or DISE:

It is a short stay procedure done with a shot of anesthesia to make the patient sleep like normal sleep. Once the snoring starts, the flexible endoscope is inserted through the nose and recording of the changes in the airway during sleep can be seen. Fluttering of the palate, narrowing of the airway and different changes are recorded during sleep

Treatment of Sleep Apnea

CPAP machine: The primary treatment is the Continuous positive airway pressure machine or the CPAP machine

  • It blows air in the airway keeping it open during sleep . This stops it from collapsing and stopping the breathing. This significantly reduces the apnea
  • It is not addictive or does not cause damage to the body as commonly believed
  • It requires some time to get used to. A variety of masks are available and humidifiers are there to help the patient be more comfortable


Surgery helps in opening the airway and improving the breathing. It prevents collapse.

It is avoided in overweight people . Types of surgery are

  • Nasal surgery-septal , sinus and turbinate surgery to improve the airflow through the nose
  • palatoplasty
  • hyoid suspension and resection of the epiglottis
  • tongue base resection
  • tonsil and adenoid surgery in young children immediately relieves their problems. They can have weight gain, bed wetting and poor performance at school

Tongue holding devices and mandible repositoning devices also help. These are simple solutions.

Please consult your doctor for proper treatment and advice. The views on the website are for information only.