Unusually persistent rhinorrhea in a patient with allergic rhinitis

Abstract

History of Present Illness A 49-year-old woman who worked as an administrative assistant presented to the allergist office with symptoms of allergic rhinitis and worsening asthma. She had been diagnosed as having asthma 5 years earlier during which time her condition was well controlled with an albuterol metered-dose inhaler used as needed. However, several months before the visit, her symptoms worsened, with coughing, wheezing, and shortness of breath that required 2 emergency department visits and 4 courses of prednisone. Her rhinitis also worsened, including nasal congestion, watery nasal discharge, sneezing fits, and postnasal drip. Symptoms were perennial and subjectively worse with dust, feather pillows, animals, grass, weed, cigarettes smoke, and heat. Most notable was the copious clear, watery rhinorrhea, which initially began 4 years ago. During that time, she noted the symptoms to occur intermittently, lasting a day or two and then recurring in a few days. Symptoms initially predominated during the winter, but the rhinorrhea gradually worsened, and 2 years later, it occurred during all seasons of the year and on a daily basis. The rhinorrhea was predominantly from the left nostril, caused a sensation of postnasal drip in the supine position, and was worse when bending forward.