Week 2 i-Human Case Study: Comprehensive Management of Environmental
Allergic Rhinitis in a 42-Year-Old Male with Perennial Symptoms – David Miller.
Includes ICD-10 codes (J30.9, H10.1, R09.82, R53.83), treatment plan, follow-
up plan.
NRNP 6550 Week 2 i-Human Case Study: Environmental Allergic Rhinitis
Management in Adult Primary Care
Comprehensive Guide for 2025/2026 Academic Year Success
by Lauren Paluch, DMSc, PA-C
,FULL CASE OVERVIEW
Case Information
Element Details
Course NRNP 6550: Advanced Primary Care of the Family
Week Week 2
Platform i-Human Patients by Kaplan
Learning Mode (formative assessment with feedback after each
Mode
section)
Lauren Paluch, DMSc, PA-C (in collaboration with the AHP Conten
Case Author
Team)
Estimated Completion
60-90 minutes
Time
Patient assessment, diagnostic reasoning, clinical decision-makin
Core Competencies
patient education
Patient Demographics
Demographic Value
Name David Miller (typical case variant)
Age 42 years
Sex Male
,Demographic Value
Height 6'0" (183 cm)
Weight 198.5 lb (90 kg)
BMI 26.9 kg/m² (Overweight)
Chief Complaint "I need help with my environmental allergies"
Chief Complaint
42-year-old male presenting to primary care with complaint of worsening
environmental allergy symptoms. He reports a history of symptoms since age 15-
16 but notes progression from seasonal (spring/fall) to perennial symptoms over
the past decade .
History of Presenting Illness
Mr. Miller presents with progressively worsening environmental allergy symptoms:
Symptom Characterization :
Symptom Description
Sneezing Paroxysmal, 3-10 sneezes in a row; occurs frequently throughout the day
Clear, watery nasal discharge; described as "like water"; requires frequent
Rhinorrhea
tissue use
Nasal
Bilateral; worse in mornings and at night; affects sleep quality
Congestion
Nasal Pruritus Itching in nose; patient performs "allergic salute" (rubbing nose upward)
, Symptom Description
Ocular
Itchy, watery eyes; bilateral; conjunctival injection
Symptoms
Post-nasal Drip Chronic; leads to throat clearing and mild throat irritation
Throat/Ear
Oropharyngeal and ear canal itching during pollen season
Itching
Pattern and Timing:
• Onset: Gradual, worsening over last 10 years
• Seasonal Pattern: Worse in spring (April-May) and fall (September-October)
• Perennial Symptoms: Dust and mold cause symptoms year-round
• Diurnal Pattern: Worse upon waking (dust mite exposure); symptoms peak
in evening
• Duration: Symptoms present >4 days per week for >4 consecutive weeks
→ Persistent classification
Triggers :
• Outdoor: Grass pollen, tree pollen, ragweed (seasonal)
• Indoor: Dust mites, mold, cat dander (perennial)
• Activities: Mowing lawn, cleaning house, exposure to basement mold
• Environment: Carpeted bedrooms, forced air HVAC, cat in home
Impact on Quality of Life:
• Work: Frequent sneezing during meetings (embarrassing); productivity
reduced ~30%
• Sleep: Disrupted by nocturnal congestion and mouth breathing; daytime
fatigue
• Social: Avoids outdoor activities during high pollen seasons
Allergic Rhinitis in a 42-Year-Old Male with Perennial Symptoms – David Miller.
Includes ICD-10 codes (J30.9, H10.1, R09.82, R53.83), treatment plan, follow-
up plan.
NRNP 6550 Week 2 i-Human Case Study: Environmental Allergic Rhinitis
Management in Adult Primary Care
Comprehensive Guide for 2025/2026 Academic Year Success
by Lauren Paluch, DMSc, PA-C
,FULL CASE OVERVIEW
Case Information
Element Details
Course NRNP 6550: Advanced Primary Care of the Family
Week Week 2
Platform i-Human Patients by Kaplan
Learning Mode (formative assessment with feedback after each
Mode
section)
Lauren Paluch, DMSc, PA-C (in collaboration with the AHP Conten
Case Author
Team)
Estimated Completion
60-90 minutes
Time
Patient assessment, diagnostic reasoning, clinical decision-makin
Core Competencies
patient education
Patient Demographics
Demographic Value
Name David Miller (typical case variant)
Age 42 years
Sex Male
,Demographic Value
Height 6'0" (183 cm)
Weight 198.5 lb (90 kg)
BMI 26.9 kg/m² (Overweight)
Chief Complaint "I need help with my environmental allergies"
Chief Complaint
42-year-old male presenting to primary care with complaint of worsening
environmental allergy symptoms. He reports a history of symptoms since age 15-
16 but notes progression from seasonal (spring/fall) to perennial symptoms over
the past decade .
History of Presenting Illness
Mr. Miller presents with progressively worsening environmental allergy symptoms:
Symptom Characterization :
Symptom Description
Sneezing Paroxysmal, 3-10 sneezes in a row; occurs frequently throughout the day
Clear, watery nasal discharge; described as "like water"; requires frequent
Rhinorrhea
tissue use
Nasal
Bilateral; worse in mornings and at night; affects sleep quality
Congestion
Nasal Pruritus Itching in nose; patient performs "allergic salute" (rubbing nose upward)
, Symptom Description
Ocular
Itchy, watery eyes; bilateral; conjunctival injection
Symptoms
Post-nasal Drip Chronic; leads to throat clearing and mild throat irritation
Throat/Ear
Oropharyngeal and ear canal itching during pollen season
Itching
Pattern and Timing:
• Onset: Gradual, worsening over last 10 years
• Seasonal Pattern: Worse in spring (April-May) and fall (September-October)
• Perennial Symptoms: Dust and mold cause symptoms year-round
• Diurnal Pattern: Worse upon waking (dust mite exposure); symptoms peak
in evening
• Duration: Symptoms present >4 days per week for >4 consecutive weeks
→ Persistent classification
Triggers :
• Outdoor: Grass pollen, tree pollen, ragweed (seasonal)
• Indoor: Dust mites, mold, cat dander (perennial)
• Activities: Mowing lawn, cleaning house, exposure to basement mold
• Environment: Carpeted bedrooms, forced air HVAC, cat in home
Impact on Quality of Life:
• Work: Frequent sneezing during meetings (embarrassing); productivity
reduced ~30%
• Sleep: Disrupted by nocturnal congestion and mouth breathing; daytime
fatigue
• Social: Avoids outdoor activities during high pollen seasons
