March Week 3 (by Dr Turek)
A 4yo girl is brought to CYAS for her annual well visit. Overall, she has been very healthy, but her mother mentions that she seems to catch colds very easily. In fact, it seems as if her nose is always running! On further questioning, you elicit from mom that her daughter often snores at night, takes frequent naps, and has developed progressively worsening dark circles under her eyes. You are concerned about allergic rhinitis (AR).
1. What additional information should you gather from the history? Consider some of the major risk factors associated with AR.
2. Identify some physical exam findings that would strengthen your presumed diagnosis. What if this child does not have any of these classic findings?
3. AR is often misdiagnosed as another cause of rhinitis in the pediatric population. Discuss the differential diagnosis and what particular clinical features are more suggestive of AR.
4. AR is not a completely benign diagnosis. What are common associated comorbid disorders? What can be the impact on this child’s quality of life?
5. Which diagnostic methods exist for AR?
6. Discuss management options for AR. How would you counsel patients on ways to practice allergen avoidance? Give specific examples. Which medication is considered first-line? When would you refer to an allergist?