Case Report on Management...

 

Patient Details

A 38-year-old male

Presenting complaints

Persistent nasal congestion, sneezing, rhinorrhea for the past two years, irritation and itchiness in his eyes and a sore throat.

Clinical examination

• Patient displayed swelling of the nasal mucosa and pale, thin nasal secretions.
• Sinus examination revealed sensitivity upon palpation.
• Examination of throat: Posterior oropharynx is moist, mucous accumulation in the back of the nose and throat, no sign of inflammation.
• Blood pressure: 138/80 mm Hg
• Heart rate: 82 rate/min
• Temperature: 99.7 F

Laboratory Investigations

• Hb% - 14.5 gm% ▪ TLC – 5800/ mm3 ▪ Neutrophils - 63%, Lymphocytes - 29%, Monocytes - 3 %, Eosinophil - 5, Basophils ▪ ESR – 30 mm/hour ▪ Absolute Eosinophil count – 595 /mm3
• Skin Prick test postitive for dust, cat and dog fur.

Diagnosis

Allergic rhinitis

Treatment

• Combination of Oxymetazoline (0.05%) and fluticasone nasal spray for nasal congestion.
• Advised to place a cold compress over eyes to soothe irritation and itching in eyes.

Follow-up

• Within 24 hours of oxymetazoline initiation, the patient reported significant improvement in nasal congestion and sneezing.
• The watery nasal discharge had also significantly decreased.
• Nasal mucosa swelling was visibly reduced during follow-up examinations.
• Laboratory investigations were within normal ranges.

Discussion

Allergic rhinitis is a widespread condition characterized by inflammation of the nasal membranes, giving rise to a spectrum of symptoms such as sneezing, nasal congestion, itching, and rhinorrhea. These symptoms may present in diverse combinations among affected individuals. Although allergic rhinitis is generally non-life-threatening, except in cases of severe asthma or anaphylaxis, it can lead to substantial morbidity for those affected. Oxymetazoline is a selective alpha-adrenergic receptor agonist that acts as a potent vasoconstrictor in the nasal mucosa, reducing swelling and congestion. The studies showed that combining oxymetazoline and fluticasone furoate effectively improved nasal symptom scores in patients with allergic rhinitis, particularly in relieving congestion. Several studies have indicated that oxymetazoline delivers more pronounced and rapid relief from nasal congestion compared to a placebo in individuals with allergic rhinitis. This case report underscores the potential advantages of incorporating oxymetazoline as a supplementary treatment for allergic rhinitis management.

Reference

1. Haenisch B, Walstab J, Herberhold S, Bootz F, Tschaikin M, Ramseger R, et al. Alpha-adrenoceptor agonistic activity of oxymetazoline and xylometazoline. Fundamental & Clinical Pharmacology. 2009 Dec 17;24(6):729–39.
2. JCDR - Allergic rhinitis, Oxymetazoline, Fluticasone, Congestion [Internet]. www.jcdr.net. Available from: https://www.jcdr.net/article_fulltext.asp?id=1846