Case study: Allergic Rhinitis

The patient is a 28-year-old woman who has been experiencing a runny nose and itchy eyes for about nine days. These symptoms typically last for six to eight weeks and occur every spring. Besides the runny nose, she reports having itchy eyes that she feels the urge to scratch, a tickling sensation in her throat, and a feeling of fullness in her ears that sometimes causes them to pop.

Case study: Allergic Rhinitis

Last year, she took Claritin with relief. Upon examination, the patient is alert and oriented and has pale nasal mucosa with clear thin secretions and enlarged nasal turbinates that obstruct airway flow, but her lungs are clear. Her tonsils are not enlarged, but her throat is mildly red.

Diagnostic Tests Justification

Based on the patient’s symptoms of a runny nose, itchy eyes, and ears that feel full, a few possible diagnostic tests that could be appropriate for this case are listed and justified below.

  1. Allergy testing: The patient’s symptoms of a runny nose, itchy eyes, and ears that feel full are consistent with allergic rhinitis, which is an allergic reaction to environmental allergens such as pollen, mold, or pet dander (McCance & Huether, 2019). Allergy testing can help confirm whether the patient has an allergy and identify the specific allergens causing the patient’s symptoms.
  2. Nasal endoscopy: A nasal endoscopy involves inserting a thin, flexible tube with a camera into the patient’s nose to visualize the inside of the nasal passages and sinuses. This test can help identify any structural abnormalities or inflammation in the nasal passages that may contribute to the patient’s symptoms.
  3. Sinus imaging: Sinus imaging tests such as CT scans or MRIs provide detailed images of the patient’s sinuses and help identify any blockages or infections that may be causing the patient’s symptoms.
  4. Throat culture: A throat culture involves taking a sample of the patient’s throat secretions and growing them in a laboratory to identify any bacterial or viral infections that may be causing the patient’s symptoms.
  5. Complete blood count (CBC): A CBC would give a depiction of the white blood cells and their differentials and show whether there is an excess of or any deficiency of the cells. Elevated eosinophils upon doing a CBC may be suggestive of an allergic condition.

Differential Diagnoses

Based on the patient’s symptoms and the diagnostic tests described above, the following five conditions should be considered in the differential diagnosis:

  1. Allergic rhinitis: As mentioned above, the patient’s symptoms of a runny nose, itchy eyes, and ears that feel full are consistent with allergic rhinitis, which is an allergic reaction to environmental allergens (Emeryk et al., 2019). Allergy testing can help confirm this diagnosis.
  2. Sinusitis: The patient’s symptoms of a runny nose and ears that feel full, as well as the presence of pale, boggy nasal mucosa and enlarged nasal turbinates, suggest the possibility of sinusitis, which is an inflammation of the sinuses (Hammer & McPhee, 2018). A nasal endoscopy or sinus imaging test can help confirm this diagnosis.
  3. Common cold: The patient’s symptoms of a runny nose, itchy eyes, and a tickle in the throat are consistent with the common cold, a viral infection of the upper respiratory tract. A throat culture can help confirm this diagnosis.
  4. Influenza: The patient’s symptoms of a runny nose, itchy eyes, and a tickle in the throat are also consistent with influenza, which is a viral infection of the respiratory tract. A throat culture or blood test can help confirm this diagnosis.
  5. Adenovirus infection: Adenovirus respiratory infection could also manifest as a runny nose, itchy eyes, and a tickle in the throat. A throat culture or blood test can help confirm this diagnosis.

Conclusion

In sum, the patient in this case study is a 28-year-old woman who is experiencing a runny nose and itchy eyes, which occur every spring and last for six to eight weeks. She also has a tickling sensation in her throat, and her ears feel full and sometimes pop.

Possible diagnostic tests for her symptoms include allergy testing, nasal endoscopy, sinus imaging, throat culture, and a complete blood count. Differential diagnoses for her condition include allergic rhinitis, sinusitis, the common cold, influenza, and adenovirus infection.

References

  • Emeryk, A., Emeryk-Maksymiuk, J., & Janeczek, K. (2019). New guidelines for the treatment of seasonal allergic rhinitis. Postepy Dermatologii i Alergologii36(3), 255–260. https://doi.org/10.5114/ada.2018.75749
  • Hammer, G. D., & McPhee, S. J. (2018). Pathophysiology of disease: An introduction to clinical medicine 8E (8th ed.). McGraw-Hill Education.
  • McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby.