RT Book, Section A1 Schroer, Brian A2 Usatine, Richard P. A2 Sabella, Camille A2 Smith, Mindy Ann A2 Mayeaux, E.J. A2 Chumley, Heidi S. A2 Appachi, Elumalai SR Print(0) ID 1114880305 T1 Allergic Rhinitis T2 The Color Atlas of Pediatrics YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 978-0-07-176701-9 LK accesspediatrics.mhmedical.com/content.aspx?aid=1114880305 RD 2024/03/29 AB 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.