Review Question - QID 102612

This patient is presenting with rhinorrhea when outside with nasal eosinophilia and boggy turbinates suggesting a diagnosis of allergic rhinitis (from an environmental allergen).

Allergic rhinitis presents with rhinorhhea and itchy/watery eyes when an individual is exposed to an irritating environmental allergen. The diagnosis is supported when the symptoms happen only during a certain exposure (such as being outside). The finding of nasal eosinophilia is sensitive for allergic rhinitis but is not specific. Other causes of nasal eosinophilia include nasal polyps and a condition known as non-allergic rhinitis with eosinophilia. Other common causes of rhinitis, such as infection and vasomotor rhinitis, do not demonstrate nasal eosinophilia. The treatment of allergic rhinitis is allergen avoidance and intranasal steroids. Other initial measures include intranasal antihistamines and alpha-1 agonists.

Incorrect Answers:
Answer 1: Cold weather can cause vasodilation of vessels in the nose and cause rhinorrhea that is not necessarily infectious or allergic. This is a diagnosis of exclusion and would be supported if the patient only had rhinorrhea when in the cold.

Answer 2: Coronavirus and rhinovirus are common causes of the "cold" which presents with a runny nose, cough, and mild fever. This condition resolves on its own.

Answer 4: Staphylococcus aureus is a common infectious agent for many dermatologic infections. A stye (hordeolum) may present with a painful nodule on the eyelid that usually drains spontaneously with a warm compress.

Answer 5: Streptococcus pneumonia, Haemophilus influenzae, and Moraxella catarrhalis are common causes of sinusitis which presents with a fever, nasal pressure, and drainage. The treatment involves saline rinses, nasal decongestants, and, if refractory, antibiotics such as amoxicillin-clavulanate.

Bullet Summary:
Allergic rhinitis presents with a runny nose and itchy eyes when exposed to environmental triggers.