From the Research
The patient should continue their current antibiotic treatment for otitis media and start albuterol 2.5mg via nebulizer or 2 puffs via inhaler every 4-6 hours as needed for wheezing or shortness of breath, as well as cetirizine 10mg daily or loratadine 10mg daily for allergic symptoms. The chest x-ray findings suggesting bronchitis/bronchiolitis, along with the swelling around the eyes after lawn mowing, indicate the need for a comprehensive treatment plan. The peribronchial thickening on chest x-ray indicates inflammation of the airways, which can be caused by infection or allergies. Since the CBC and CMP are normal, this suggests the inflammation may be allergic rather than infectious in nature. The temporal relationship between lawn mowing and eye swelling strongly suggests environmental allergies as a contributing factor to both the eye symptoms and possibly the bronchial inflammation, as supported by the study on evidence-based use of antihistamines for treatment of allergic conditions 1.
For the allergic symptoms, it is essential to consider the potential for hypersensitivity to antihistamines, as reported in the study on hypersensitivity to antihistamines 2. However, the benefits of using antihistamines, such as cetirizine or loratadine, in this case, outweigh the risks, and the patient should be monitored for any adverse reactions. The study on managing food allergy when the patient is not highly allergic 3 is not directly relevant to this case, as the patient's symptoms are more indicative of environmental allergies rather than food allergies.
Key considerations for the patient's treatment plan include:
- Continuing current antibiotic treatment for otitis media
- Starting albuterol for bronchitis/bronchiolitis symptoms
- Using cetirizine or loratadine for allergic symptoms
- Advising the patient to wear protective eyewear and a mask when mowing
- Considering the addition of fluticasone nasal spray if symptoms persist
- Monitoring for potential hypersensitivity to antihistamines
- Encouraging hydration and rest to aid in recovery from both the ear infection and bronchial inflammation.