A 21-year-old man comes to the office due to nasal congestion and rhinorrhea. It occurs intermittently and is often accompanied by sneezing and itchy, watery eyes. It began 2 years ago and has worsened in severity. On examination, the nasal turbinates are edematous with clear rhinorrhea. There is bilateral conjunctival injection. Which of the following questions would be most helpful during further workup of this patient's condition?

Question

A 21-year-old man comes to the office due to nasal congestion and rhinorrhea.  It occurs intermittently and is often accompanied by sneezing and itchy, watery eyes.  It began 2 years ago and has worsened in severity.  On examination, the nasal turbinates are edematous with clear rhinorrhea.  There is bilateral conjunctival injection.  Which of the following questions would be most helpful during further workup of this patient's condition?

Quizplus · Accepted Answer

This patient has nasal congestion, sneezing, and rhinorrhea accompanied by conjunctivitis. This is consistent with allergic rhinoconjunctivitis, a type 1 hypersensitivity that triggers an allergic response via the binding of a previously recognized antigen to IgE antibodies on mast cells. Because exposure to allergens results in a rapid allergic response and avoidance of allergens improves symptoms, patients can often distinguish patterns to their reactions. Typical patterns include the following: Seasonal variation: The variation is often related to specific pollinators at particular times of the year. Geographical variation: Symptoms improve when patients are not exposed to the typical allergens of the region (eg, going on vacation). Animal exposure: Symptoms occur when visiting a house with pets or begin shortly after animal acquisition. Indoor versus outdoor: Patients with predominantly indoor symptoms may have an allergy to dust mites; outdoor symptoms suggest pollinators. (Choice A) An allergic reaction to soy products can cause nasal and ocular symptoms. However, it also typically includes a rash, swelling or itching of the mouth and lips, and/or gastrointestinal symptoms. In addition, it most commonly presents in early childhood when soy is introduced into the diet. (Choice C) Rhinitis symptoms caused by exposure to cold air are classically associated with nonallergic or vasomotor rhinitis. Nonallergic rhinitis typically does not cause conjunctivitis symptoms. (Choice D) Tobacco smoke is a respiratory irritant that can worsen symptoms of allergic rhinitis; however, tobacco allergy is rare, and depending on route of intake, would likely produce significant oral (eg, mouth itching/swelling) and pulmonary (eg, asthma) symptoms. (Choice E) Like allergic rhinitis, medication allergies can be type 1 hypersensitivity reactions. However, these allergies typically present with an urticarial rash shortly after ingestion of the medication; eye symptoms are uncommon. Educational objective: Allergic rhinitis often causes nasal congestion, sneezing, rhinorrhea, and conjunctivitis due to an IgE-mediated hypersensitivity response. Patients can often distinguish patterns that suggest reactions to specific allergens.

A 21-Year-Old Man Comes to the Office Due to Nasal