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Persistent allergic rhinitis — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CarePersistent allergic rhinitisUSMLE Step 3

A 47-year-old woman has persistent allergic rhinitis despite oral cetirizine. She has nasal congestion, sneezing, and itchy eyes every spring. Exam shows pale boggy nasal mucosa. She has no asthma. Which of the following is the most appropriate next step in management?

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Correct answer: D — Intranasal corticosteroid

Intranasal corticosteroids are the most effective first-line pharmacologic therapy for persistent allergic rhinitis. Antibiotics and chronic systemic steroids are not appropriate.

Reference: American Academy of Allergy, Asthma & Immunology rhinitis guidance