Man, I wish I could help.  I know what you are going through, but
unfortuantely there aren't the answers we are looking for in this board or
with traditional medicine.  I am thinking about trying xolair.  The risk of
cancer associated with that drug bothers me, because my family seems to have
a genetically predisposition for cancer.  Good luck I am not having much of
that.

Well - first off - people do develop allergies and asthma all through
life so, especially in a person with a history of allergies, this could
just be an adult onset of asthma with no identifiable cause.

However, I do think there are a number of things that should be
considered.

The most obvious consideration is that it is just sinus disease that is
triggering the asthma symptoms. You should be following up with the ENT
and have had some scans to make sure the problem is not there. If it is
prolonged courses of antibiotics, including some that cover anaerobes
(clindamycin, flagyl, Avelox (sort of), and Augmentin would be a few).
Cultures should be taken during any surgeries to make sure there is not
just a resistance problem or a fungal infection. Barring that long
courses of different antibiotics may need to be given to get arround
any resistance which should include drugs that often treat drug
resistance staph and strep like clindamycin, doxycyline, and Bactrim.
4-8 weeks is a commonly needed treatment length for true bacterial
sinusitis.

Another consideration is to make sure you do not have other causes of
nasal and lung symptoms such as sarcoid (ACE level), Wegener's
Granulomatosis (nasal musoca biopsy and ANCA levels), or fingal
infections (Histoplasma and others depending on where you live). I see
they have given some consideration to things like reflux and allergies
which you should agressively persue.

The fact that the problems started after an infectious illness and as
an adult does suggest that mycoplasms or chlaydia infection is possible
and the test couldn't hurt. The problem is that we really haven't
worked out the details on what to test and what to call positive so I
am not sure a negative test should preclude a trial of treatment.

The decision to treat involves weighing the risks vs. the potential
benefits. In your case you have likely been and will likely be again
subjected to long courses of antibiotics so I am not sure you would be
avoiding any risk by not trying a 12 week course of azithromycin. Also
when you compare the antiobiotics to long term or frequent prednisone
then the antibiotics have a clear advantage. Unfortunately, I think
that the highest odds of success you could hope for would be 50% - and
it is probably somewhat less - like around 30%.

The big problem would be which antibiotic to use. The best evidence for
treating chronic chlamydia and mycoplasma infections is for
azithromycin (Zithromax - Z-pack). It seems to work better and faster
than the other ones that might be expected to possibly work. But
azithromycin has a wierd mechanism of action. It tends to concentrate
in the white cells and so the theory goes that it gets transported to
the sites of infection in that way. The serum levels are very low (but
maybe the infection site levels are high) so many docs don't consider
it a good choice for sinusitis. They would probably prefer
erythromycin, doxycycline,  clarithromycin (Biaxin), or one of the
extended spectrum flouroquinolones (Levaquin, Avelox, Tequin) all of
which are listed as killing the two bugs in the books but don't seem to
work as well as the azithromycin in the studies that have neen done on
this situation. So the best drugs for common considerations of sinus
disease would be the others but for these two organisms in particular
would be azithromnycin and you may have a discussion on your hands
about which to use.

Good luck.