Case 067: Allergic Rhinitis

PATIENT PRESENTATION

Chief Complaint

“I cannot stop sneezing and itching my nose”

History of Present Illness

Anita Tissue is a 26-year-old female that presents with frequent sneezing and nasal itch for the last several weeks since the desert started to bloom. She endorses ongoing nasal drainage and congestion, as well as occasional watery eyes, without relief. She shares that her symptoms have affected her sleep and ability to function at work (she works at the local botanical gardens).

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. Which of Anita’s symptoms are suggestive of a diagnosis of allergic rhinitis??

   Hint: See Table 65-1 in PPP

2. Define her classification of allergic rhinitis and what criteria supports this classification?

   Hint: See Table 65-3 in PPP

3. What are possible non-pharmacologic and pharmacologic treatment options for her allergic rhinitis?

   Hint: See Treatment along with Table 65-4, 65-5, 65-6, 65-8 in PPP

4. Please describe an initial pharmacologic plan to help treat this patient’s condition. Please address alternatives as appropriate.

   Hint: See Treatment and Tables 65-5, 65-6, 65-8 in PPP

5. What counseling and education points should be discussed with the patient initiating therapy?

   Hint: See Treatment and Table 65-7 in PPP

FOLLOW-UP

How would your recommendations change (see question 4) if the patient was asking for recommendations to help her 4-year-old child with similar symptoms?

Hint: See Treatment in PPP

CASE SUMMARY

Global Perspective

Allergic rhinitis is a common condition triggered by exposures to allergens, impacting 10-30% of the global population, with rising incidence. The prevalence of allergic rhinitis varies between socioeconomic status within the affected patient population, with a higher incidence in children and adolescents. Due to the high prevalence, this disease presents significant burdens to the quality of life in patients that are not adequately treated. There is a significant population of patients self-treating allergic rhinitis with suboptimal over-the-counter medications, without medical provider diagnosis or guidance, allowing meaningful opportunities for pharmacy intervention.