A 17 Year old male complains of recurrent episodes of cough, wheeing and shoness of breath paicularly at night for the last 3 days. His sibling has a history of similar symptoms. A skin test with pollen produces immediate wheal and flare. He should be treated with
**Core Concept**
The patient's symptoms of cough, wheezing, and shortness of breath, particularly at night, in conjunction with a positive skin test to pollen, suggest allergic rhinitis and asthma. The pathophysiology involves an IgE-mediated allergic reaction, leading to the release of histamine and other mediators from mast cells, causing airway inflammation, constriction, and hyperresponsiveness.
**Why the Correct Answer is Right**
The patient's symptoms are consistent with seasonal allergic rhinitis, which is exacerbated by pollen exposure. The immediate wheal and flare response to pollen on skin testing confirms an IgE-mediated allergic reaction. Treatment with a bronchodilator (e.g., beta-2 agonist) can help alleviate acute symptoms, but long-term management involves controlling symptoms with medications that reduce inflammation and prevent allergic reactions, such as inhaled corticosteroids (ICS).
**Why Each Wrong Option is Incorrect**
**Option A:** This option is not specified, but we can infer that it might be a non-steroidal anti-inflammatory drug (NSAID) like ibuprofen. While NSAIDs can help with pain and inflammation, they do not address the underlying allergic reaction and may even worsen asthma symptoms by inhibiting prostaglandin synthesis, which can lead to bronchoconstriction.
**Option B:** A systemic corticosteroid like prednisone might be considered for severe allergic reactions or asthma exacerbations, but it is not the first-line treatment for long-term management of allergic rhinitis and asthma.
**Option C:** This option is not specified, but we can infer that it might be a decongestant like pseudoephedrine. While decongestants can provide temporary relief from nasal congestion, they do not address the underlying allergic reaction and may even worsen asthma symptoms by causing vasoconstriction and increasing blood pressure.
**Option D:** This option is not specified, but we can infer that it might be a leukotriene modifier like montelukast. While leukotriene modifiers can help control symptoms of allergic rhinitis and asthma, they are not the most effective treatment for acute symptoms and are often used as add-on therapy to ICS.
**Clinical Pearl / High-Yield Fact**
In patients with allergic rhinitis and asthma, it's essential to use a combination of medications that address both inflammation and bronchospasm, such as ICS plus a long-acting beta-agonist (LABA). This combination can provide more effective symptom control and prevent exacerbations than using either medication alone.
**Correct Answer:** D.