USMLE STEP 3 MCQ 44:An 8-year-old boy regularly experiences moderately severe sneezing spells



An 8-year-old boy regularly experiences moderately severe sneezing spells and watery eyes in May and June, September and October, and occasionally during January through March. Immediate skin test show a positive reaction to Alternaria, Cladosporium, house dust and grass and ragweed pollens. The most appropriate treatment would include

a) Antigen avoidance
b) immunotherapy against the known offending antigen
c) Antihistamine-decongestant preparation
d) Topical adrenergic agonist
e) oral adrenergic agonist

Correct Answer: C


Antihistamine-decongestant preparations remain the initial drug of choice for allergic rhinitis. Nasal cromolyn sodium, which in some cases is as effective as an antihistamine-decongestant in treating seasonal allergic rhinitis, could have been recomended for the 8-year-old boy with seasonal symptoms. Administration to nasal cromolyn sodium, however, requires the patient to carry a nasal pump and administer the reatment approximately four times daily prior to expected antigen exposure, making it inconvenient for some patients. Patients who cannot tolerate oral medications may respond to cromolyn sodium, however. It is sometimes effective for perennial allergic rhinitis, but is more often used to alleviate acute seasional symptoms.

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