### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I have had a cough for many months that comes and goes and is a result of an itchy throat , doctors had prescribed me as asthmatic and I used an inhaler that worked and my cough got better and whenever I get a cold my cougChatDoctores back. It feels like I have dust in my throat. This as I said has been going on for a while and I have been back about 6 - 7 times in the last year with the cough going away and then coming back again. They are not very helpful and say that because I am 27, a non smoker and live a relatively healthy life it is asthma - I am not convinced. A new symptom has now arisen - I have a lot of phlegm and my nose has been bleeding on an off for a week or so - this i assumed was because I was blowing my nose too much but in the last couple of days the blood is thickening and becoming strands that look like worms and then come up with clear phlegm. I have read a few internet blogs saying that they are parasitic worms, they do look like worms but are not moving. They look like blood clots but wanted to double check if there is something that I can do about them or if they are a final result of my coughing and blowing my nose. Once the blood comes up my nasal passage feels a lot clearer. If you can help that would be amazing. As a backgroud - I was bron with a cleft palat that was only diagnosed when I was four as I did not have the lip thing. I have subsequently had problems with my ears and nose and often find it hard to breathe through my nose and suffer from allergies during the summer.

### output:

Hello, Thank you for writing to us. It does seem that you have moderate to severe persistent rhinitis/rhinosinusitis. House dust mite allergy must definitely be excluded. You can get skin prick tests or specific IGE blood tests to know all your allergies. Blood mixed with nasal secretions can appear like streaks and are NOT worms. If you have parasitic disease in your airways and coming out of the nose, it happens in tropical pulmonary eosinophilic due to filial worms and believe me, you will be quite unwell! Long acting oral antihistamines plus nasal sprays (either Flonase or flumast-AZ with elastane) 2 sprays per nostril twice daily for 2 months is the initial treatment duration for severe house dust mite allergy. I hope this was useful. Best Wishes.