A 29-year-old non-smoker man presents with sneezing, post-nasal drip, eye-watering, and an itch of his posterior pharynx. These symptoms tend to be worse in the spring and summer and have been bothering him since mid-April, about 1 month ago. His past medical history is remarkable only for mild asthma induced by being outdoors. He takes no regular medications but does take diphenhydramine on occasion. Most appropriate diagnostic test at this time is?
Correct Answer: None, the diagnosis is based solely on the history and physical examination
Description: This patient most likely has seasonal allergic rhinitis. It has been shown quite convincingly that the diagnosis is based on the history and physical alone and that fuher work-up is not cost-effective and should be reserved for refractory cases. The blood radioallergosorbent test reliably detects allergen-specific IgE antibodies in the serum and quantifies their concentrations. Intradermal testing involves the introduction of a measurable amount of allergen into the dermal layer of the skin. Serum protein electrophoresis is not routinely used to aid in the diagnosis of rhinitis. It is commonly used in the diagnosis of sickle cell disease and multiple myeloma.Skin-prick testing involves the application of a small amount of concentrated allergen to the skin; it is then "pricked" through to the epidermal layer. This type of testing is less sensitive than intradermal testing. Ref - Harrison's principles of internal medicine 20e
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