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Otolaryngology
infectious conditions
allergic rhinitis
A 28-year-old man presents to an urgent care facility with a two-month history of intermittent nasal congestion, clear rhinorrhea, and ocular pruritus, particularly pronounced during spring mornings and when exposed to pet dander. He reports that over-the-counter pseudoephedrine provides only transient relief. His temperature is 37.00C, blood pressure is 128/78 mmHg, pulse is 72/min, respirations are 16/min, and oxygen saturation is 99% on room air. Physical examination reveals bilateral pale, boggy nasal turbinates and clear nasal discharge. Mild conjunctival injection is noted, but there is no purulent discharge or facial tenderness to palpation. Nasal sputum cytology reveals significant eosinophilia. Considering his presentation, what is the most likely underlying diagnosis and the most appropriate initial management strategy?
| Lab Parameter | Value | Reference Range |
|---|---|---|
| White Blood Cell Count | 7.2 x 10^9/L | 4.0-11.0 x 10^9/L |
| Neutrophils | 55% | 40-75% |
| Lymphocytes | 35% | 20-45% |
| Eosinophils | 7% | 1-6% |
| Hemoglobin | 145 g/L | 130-170 g/L |
| Platelets | 280 x 10^9/L | 150-400 x 10^9/L |
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