What is the recommended drug regimen for a 52-55 year old woman with a history of allergic rhinitis, presenting with cough and nasal irritation, exacerbated by dust, fast food, and curd, and previously self-medicating with antibiotics, with a past history of cholecystectomy (gallbladder removal)?

Differential Diagnosis

The patient's symptoms of cough, nasal irritation, and respiratory problems triggered by dust, fast food, and curd, suggest an allergic or hypersensitivity reaction. Considering her history of self-medication with antibiotics and past surgical removal of the gallbladder, the following differential diagnoses are proposed:

• Single most likely diagnosis + Allergic Rhinitis: The patient's symptoms of cough, nasal irritation, and sneezing in response to dust and certain foods are consistent with allergic rhinitis. The fact that she experiences relief with antibiotics, which may have anti-inflammatory properties, further supports this diagnosis.
• Other Likely diagnoses + Asthma: The patient's respiratory problems, such as cough and wheezing, triggered by dust and certain foods, could be indicative of asthma. The fact that she experiences relief with antibiotics may also suggest a component of airway inflammation. + Gastroesophageal Reflux Disease (GERD): The patient's symptoms of cough and respiratory problems after eating certain foods, such as fast food and curd, could be related to GERD, which can cause stomach acid to flow up into the throat and trigger respiratory symptoms.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.) + Aspirin-Exacerbated Respiratory Disease (AERD): Although less likely, AERD is a condition that involves asthma, nasal polyps, and sensitivity to aspirin and other NSAIDs. If the patient is taking NSAIDs or aspirin, this condition could be life-threatening if not recognized. + Cystic Fibrosis: Although rare in adults, cystic fibrosis can present with respiratory symptoms, such as cough and wheezing, and gastrointestinal symptoms, such as malabsorption. If the patient has a family history or other suggestive features, this diagnosis should not be missed.
• Rare diagnoses + Eosinophilic Esophagitis: This condition involves an allergic inflammatory response in the esophagus, which can cause respiratory symptoms, such as cough and wheezing, after eating certain foods. + Sulfite Sensitivity: Some people may be sensitive to sulfites, which are commonly used as preservatives in foods, such as fast food and processed meats. This sensitivity can cause respiratory symptoms, such as cough and wheezing.

Drug Regimen

Based on the most likely diagnosis of allergic rhinitis, the following drug regimen is suggested:

• Antihistamines: Such as loratadine or cetirizine, to relieve symptoms of allergic rhinitis.
• Nasal Corticosteroids: Such as fluticasone or triamcinolone, to reduce inflammation and congestion in the nasal passages.
• Bronchodilators: Such as albuterol or salmeterol, to relieve respiratory symptoms, such as cough and wheezing.
• Avoidance of triggers: The patient should be advised to avoid exposure to dust, fast food, and curd, which trigger her symptoms.

Note: The patient's history of self-medication with antibiotics should be addressed, and she should be educated on the proper use of antibiotics and the potential risks of overuse.