Allergic Rhinitis

CC., 42 year old, female, married, visited the clinic for frequent sneezing usually in the morning occurring for more than a month, with associated watery nasal congestion clearing after a few hours, occasional itchy eyes with no fever and body pain. Patient claims symptoms started when they moved in a new apartment.
After careful history and thorough physical examination, patient was advised on appropriate environmental measures and was given :

Cetirizine 20mg tab daily
Momethasone Aqueous Nasal Spray 2 sprays in each nostril once daily


Characteristic physical appearance of patients with allergy

Eyes
Patients may have injected conjunctiva; increased lacrimation; and
long, silky eyelashes.
Dennie-Morgan lines (creases in the lower eyelid skin) and allergic
Shiners (dark discoloration below the lower eyelids) caused by venous
stasis may be present.

Nose
A transverse nasal crease may be present because of the patient's
repeated lifting of the nasal tip to relieve itching and open the
nasal airway.
The turbinates are frequently hypertrophic and covered with a boggy
pale or bluish mucosa.
Nasal secretions can range from clear and profuse to stringy and
mucoid.
The presence of polyps does not necessarily indicate that the affected
individual has allergic rhinitis.

Face
Patients with allergic rhinitis frequently grimace and twitch their
face, in general, and nose, in particular, because of itchy mucus
membranes.
Chronic mouth breathing secondary to nasal congestion can result in
the typical adenoid facies.

Environmental controls and Avoidance of Allergens

Individuals who have seasonal allergies should avoid outdoor activities
when allergens are in the air. Home, rooms and workplace
should be kept as clean as possible since
house dust mites thrive in warm, humid conditions, and the antigen is
found in their feces. Control measures include removing reservoirs
like carpets, stuffed toys and heavy drapes.