Question

A 24 year old student seeks treatment for nasal congestion, sneezing, and a runny nose. His symptoms occur daily for four to six weeks every year in the spring and fall, and are worse when he is outdoors or doing yardwork. Recently, he has been taking over-the-counter pseudophedrine and chlorpheniramine, but these have not significantly improved his symptoms. The patient's family history includes a mother with asthma and a brother with eczema. On physical exam, the conjunctivae are injected, and the patient's palpebrae are swollen. The nasal turbinates are boggy and edematous, and are bluish-gray in color. There is no lymphadenopathy or thyromegaly. Which of the following is the most appropriate step in the management of this patient?

A. diphenhydramine
B. fexofenadine
C. nasal beclomethasone
D. guaifenasin
E. IgE levels

Answer 1

The most appropriate next step in management for a student presenting with symptoms of allergic rhinitis unresponsive to over-the-counter medications is a nasal corticosteroid, such as nasal beclomethasone, which addresses inflammation and allergic symptoms effectively with fewer systemic side effects.

Step-by-step explanation:

Given the ineffectiveness of over-the-counter decongestants and antihistamines like pseudoephedrine and chlorpheniramine, along with a family history of atopic conditions such as asthma and eczema, the most appropriate next step in management would be C. nasal beclomethasone. Nasal beclomethasone is a corticosteroid that helps to reduce inflammation and allergic symptoms, and because it is administered locally in the nasal passages, it typically has fewer systemic side effects compared to oral steroids. This drug will address inflammation (boggy and edematous turbinates) and other allergic symptoms (nasal congestion, sneezing, and a runny nose).