Anna Sanchez, a 21-year-old nursing student, comes to her nurse practitioner in December with a 5-week
history of itchy eyes and nasal congestion with watery nasal discharge. She also complains of a “tickling”
cough, especially at night, and she has had episodes of repetitive sneezing. She gets frequent “colds” every
spring and fall.
Vital Signs: Afebrile; respiratory rate, pulse, and blood pressure all normal
Skin: Flaking erythematous rash on the flexor surfaces of both arms
Head, Eyes, Ears, Nose, and Throat: Tender over maxillary sinuses; sclera red and slightly swollen with
frequent tearing; outer nares with red irritated skin; internal nares with red, boggy, moist mucosa and one
medium-sized polyp on each side; pharynx slightly erythematous with clear postnasal drainage (NOTE: Nasal
polyps are common in allergic rhinitis. They are edematous protrusions of the mucosa that are infiltrated with
neutrophils, eosinophils, and plasma cells.)
Lungs: Clear to auscultation and percussion
Initial Post: Answer the following questions about Anna Sanchez and her condition.
What evidence suggests that Anna does not have an acute severe infection?
If Anna has allergic rhinitis, what type of hypersensitivity reaction is involved?
A skin test indicates that Anna is allergic to cat dander. Two months ago, Anna’s roommate brought home a
cat. Why didn’t Anna’s symptoms start when the cat entered the household, rather than 3 weeks later?
What class of antibodies bind to the mast cells?
What physiological mechanisms caused the redness of Anna’s nasal mucosa?
What mechanisms caused Anna’s clear postnasal drainage?