Category: For Allergy Fellows  

Teaching Case 3: Recurring Nasal Congestion and Cough

This patient has no known medical or allergic history.  Two years ago he was seen in an ER for cough and nasal congestion.  He was treated with albuterol then discharged on a nasal steroid spray which he took for a few months.  Symptoms have gradually returned since.  The cough is nocturnal and associated with dyspnea but not wheeze.  There is no  seasonal pattern to his symptoms, hyposmia, or history of sinusitis.

Examination was unremarkable, PFTs normal and allergy skin testing strongly positive to dust mites at the scratch level.

Nasal Endoscopy:

Thorough flexible endoscopic examination identified at least 2 regions of meatal involvement but the bilateral disease suggests that there is probably pansinusitis with polyps. This patient was treated with a brief burst of oral steroids, nasal steroids and a leukotriene modifier. There was a trickle of midmeatal mucous but antibiotics were deferred.

Message: Identifying the polyps led to a more aggressive approach with a burst of low dose prednisone, Singulair and nasal steroids.