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A 9-year-old girl presents to her pediatrician for constant nasal congestion, runny nose, and intermittent bouts of sneezing and itching. Her symptoms occur year-round with increased symptoms in the spring and fall. On examination she has dark circles under her eyes (“allergic shiners”; Figure 215-1), bilateral conjunctivitis (Figure 215-2), swollen, pale, inferior turbinates, and a copious clear watery nasal discharge (Figure 215-3). Over-the-counter antihistamines have helped minimally so she is given a prescription for a nasal steroid spray to use daily. This significantly improves but does not eliminate the symptoms. She is seen by an allergist who obtains a history that she sleeps on feather pillows, lives with two cats, and also has eye itching and redness when outside in the spring. Skin prick testing to local environmental allergens shows positive reactions to dust mites, cats, and grass and ragweed pollens (Figures 215-4 and 215-5). Recommendations for avoidance of the dust mites, cats, and the outdoor pollens were given. Her technique and adherence with the nasal steroids was discussed and she was given nasal antihistamines to treat breakthrough symptoms.
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Allergic rhinitis is a syndrome of upper airway symptoms in patients who are sensitive to aeroallergens including but not limited to animal dander, dust mites, mold spores, pollen, cockroaches, and rodents. Many patients have a history of atopic dermatitis, allergic rhinitis and asthma that together make up the “atopic triad.” These symptoms may be present in a seasonal pattern or year-round with seasonal exacerbations.
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Hay fever, Allergies, Pollinosis, the ...