A 14-Year-Old Boy Is Brought to the Office Due to Intermittent

A 14-year-old boy is brought to the office due to intermittent rhinorrhea, nasal congestion, and nasal itching for the past 2 months.  He has also had periodic itchy, watery eyes and an occasional daytime cough.  The boy's symptoms occur usually after he plays with a neighbor's cat, and they cause the boy to be more tired than usual and have difficulty sleeping.  He has had no fever, headache, weight loss, or sick contacts.  The patient has atopic dermatitis and was hospitalized for bronchiolitis at age 2.  He uses a topical corticosteroid ointment as needed, and his immunizations are up to date.  Family history is significant for a younger brother with asthma.  Vital signs are within normal limits.  Physical examination shows a well-appearing boy with dark, edematous lower eyelids and pale, boggy turbinates with clear rhinorrhea.  Lungs are clear to auscultation.  Skin examination shows dry, scaly patches in the antecubital fossae bilaterally with associated excoriations.  Which of the following is the most effective long-term strategy for relief of this patient's symptoms?

A) Avoidance of the cat
B) Intranasal cromolyn sodium
C) Intranasal decongestant
D) Oral corticosteroid
E) Second-generation antihistamine

Correct Answer:

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