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Chapter 64. Allergic Rhinitis

Which of the following are classic symptoms of allergic rhinitis that can be treated with an intranasal corticosteroid? Select all that apply.

a. Rhinorrhea

b. Congestion

c. Sneezing

d. Fever

Answers a, b, and c are correct. Rhinorrhea, congestion, and sneezing are classic symptoms of allergic rhinitis.

Answer d is incorrect. Fever may be a sign of infection.

KW is a 45-year-old woman who experiences daily rhinorrhea despite the use of loratadine and intranasal fluticasone. Addition of which of the following medications would best target the symptoms of rhinorrhea?

a. Azelastine

b. Ipratropium

c. Oxymetazoline

d. Phenylephrine

Answer b is correct. Intranasal ipratropium specifically targets the symptom of rhinorrhea due to its antisecretory effects. Patients with problematic rhinorrhea despite existing drug therapy may benefit from addition of an intranasal anticholinergic agent such as ipratropium.

Answer a is incorrect. Since KW is already taking an oral antihistamine, addition of a topical antihistamine does not provide additional benefit.

Answer c is incorrect. Intranasal decongestants do not improve rhinorrhea, only nasal congestion.

Answer d is incorrect. Oral decongestants are best for congestion, not rhinorrhea.

MH is a 37-year-old man with a history of chronic nasal stuffiness. He reports symptoms all year round. His only other medical condition is high blood pressure. In addition to stuffiness, he has been sneezing a lot at work (which he finds very embarrassing). Also, his symptoms have caused him to cancel park outings with his family. Which of the following best classifies MH's symptoms?

a. Mild intermittent

b. Moderate-to-severe intermittent

c. Mild persistent

d. Moderate-to-severe persistent

Answer d is correct. His symptoms are severe and chronic.

Answer a is incorrect. Since this patient's symptoms are affecting his quality of life, they are not mild. Also, since his symptoms are >4 d/wk and >4 consecutive weeks, they are persistent.

Answer b is incorrect. His symptoms are year round.

Answer c is incorrect. His symptoms affect his quality of life.

MH is a 37-year-old man with a history of chronic nasal stuffiness. He reports symptoms all year round. His ...

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