Updated: 8/11/2019

Allergic Rhinitis

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Snapshot
  • A 15-year-old boy presents with clear fluid discharge from his nose for 2 days duration. His also reports having episodes of sneezing, feelings of congestion, and a cough. His symptoms only occuring during the spring months and finds it difficult to walk outside without exacerbating his symptoms. On nasal exam, the mucosa and turbinates appear edematous. 
Introduction
  • Definition
    • inflammation of the mucosa of the nasal passages
  • Rhinitis types
    • allergic rhinitis
    • nonallergic rhinitis
      • etiologies include
        • vasomotor
        • hormonal
        • drug-induced
        • occupational (secondary to irritant exposure)
        • pregnancy
  • Epidemiology
    • incidence
      • allergic rhinitis is the most common form of rhinitis
  • Etiology
    • aeroallergens 
  • Pathogenesis
    • aeroallergens leads to an IgE type I hypersensitivity and mast cell degranulation
  • Associated conditions
    • sinusitis
    • asthma
    • atopic dermatitis
    • allergic conjunctivitis
    • nasal polyps
Presentations
  • Symptoms
    • sneezing
    • congestion
    • rhinorrhea
    • nasal itching
Studies
  • Making the diagnosis
    • this is a clinical diagnosis
  • Allergic skin testing
    • confirms that the patients has an allergy to the aeroallergen
      • is not necessary for the diagnosis
Differential
  • Nonallergic rhinitis 
    • drug-induced rhinitis
      • differentiating factors
        • onset after starting the inciting medication (e.g., angiotensin-converting enzyme inhibitors and phosphodiesterase-5 inhibitors)
    • occupational rhinitis
      • differentiating factors
        • caused by allergens or irritants in the workplace
    • atrophic rhinitis
      • differentiating factors
        • seen in older patients who had many sinus and nasal surgeries
Treatment
  • Conservative
    • allergen avoidance
      • indication
        • a component of the management of rhinitis
  • Medical
    • glucocorticoid nasal sprays 
      • indication
        • first-line treatment for persistent or moderate-to-severe allergic rhinitis
      • medications
        • budesonide
        • fluticasone
Complications
  • Respiratory tract infections
 

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Questions (4)
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(M2.ET.17.4867) A 25-year-old woman presents to the urgent care clinic for cough for the past five days. She recently moved to the area and has not yet established a primary care doctor. She has noticed worsening runny nose with congestion, sneezing, and tearing over the past few days. She initially thought that it was just due to dust from moving boxes into her new apartment, but her symptoms did not improve after cleaning her belongings and vacuuming her floor. She feels some relief after splashing her face with cold water, but her symptoms recur within ten minutes. She has no pets and does not take any medications. Her physical exam reveals examples of findings shown in Figures A-C. No rales or wheezes are appreciated on lung auscultation, but bronchial breath sounds are heard at the bases. The patient states that she will need to drive back home after this visit. What is the best initial step in management? Tested Concept

QID: 109575
FIGURES:
1

Oral loratadine

49%

(22/45)

2

Intranasal corticosteroids

42%

(19/45)

3

Intravenous diphenhydramine

4%

(2/45)

4

Sublingual oseltamivir

2%

(1/45)

5

Oral montelukast

2%

(1/45)

M 7 D

Select Answer to see Preferred Response

(M2.ET.17.4689) A 20-year-old female presents to your clinic for evaluation. She complain of months of daily rhinorrhea, which she describes as watery and clear, as well as nasal congestion bilaterally. In addition, she reports frequent watery and itchy eyes, as well as daily sneezing. Her temperature is 100.1 deg F (37.8 deg C), blood pressure is 120/70 mmHg, pulse is 70/min, and respirations are 15/min. On exam, you note edematous, boggy turbinates with watery rhinorrhea. Which of the following is a treatment for the patient’s condition? Tested Concept

QID: 107564
1

Intravenous penicillin

0%

(0/4)

2

Oral amoxicillin

0%

(0/4)

3

Oral acetaminophen

0%

(0/4)

4

Intranasal fluticasone

100%

(4/4)

5

Intravenous vancomycin

0%

(0/4)

M 7 C

Select Answer to see Preferred Response

(M3.ET.15.13) A 35-year-old woman presents to an outpatient clinic during winter for persistant rhinorrhea. She states it is persistent and seems to be worse when she goes outside. Otherwise, she states she is generally healthy and only has a history of constipation. Her temperature is 98.7°F (37.1°C), blood pressure is 144/91 mmHg, pulse is 82/min, respirations are 14/min, and oxygen saturation is 98% on room air. Nasal sputum cytology reveals eosinophilia and boggy turbinates. Which of the following is the most likely diagnosis? Tested Concept

QID: 102612
1

Cold weather

0%

(0/5)

2

Coronavirus

20%

(1/5)

3

Environmental allergen

80%

(4/5)

4

Staphylococcus aureus

0%

(0/5)

5

Streptococcus pneumonia

0%

(0/5)

M 10 E

Select Answer to see Preferred Response

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Topic COMMENTS (3)
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