Category: For Allergy Fellows  

Teaching Case 2: It sounds like seasonal allergy, but it’s not

This patient has 5 years of apparent seasonal allergy symptoms which are worse this spring.  Symptoms include sore throat, clogged ears and pruritis of the eyes, nose and throat.  There is sinus discomfort over the nasal bridge with some sneezing.  She has a lot of posterior rhinorrhea.  She seems to be prone to frequent colds.  In between colds she still has some throat discomfort.  Last week she also had dyspnea with wheeze, cough and chest tightness.   Antihistamines are ineffective.

Examination is normal.

Pulmonary Function Testing is normal.

Allergy Testing is negative, both scratch and intradermal.

Nasal Endoscopy:

Take home message:
Some patients with non-allergic respiratory illnesses present in hayfever season, drawn to the office by media reports about seasonal allergies or friends with similar symptoms. History alone does not readily distinguish some of them. The classic features of allergy were pruritis but the abundant posterior rhinorrhea, asthma symptoms and frequent colds suggested this may be more than typical seasonal allergy.