D: What brings you in?

P: Hi I'm here with my son and he's just been feeling awful. He just has this runny nose and he's been sneezing all the time and uh I don't know maybe he has allergies or something? I just came in 'cause I wanted to get him checked out and maybe get some medications. He's just feeling horrible.

D: Yeah, for sure when did when did the sneezing and runny nose start?

P: He he's had it for um, he's just always kind of, you know he's always having that runny nose. You know kids always do but it's just been pretty bad over the past um two weeks.

D: Past two weeks. OK. What started first, the sneezing or runny nose?

P: Uh the runny nose kind of just got worse a little bit over the past uh two weeks and then the sneezing kind of started at about the same time.

D: OK and and the runny nose is he having um like what colour is it?

P: It's just clear like.

D: Clear. OK. Does he ever feel like he's uh, do you ever feel like he's stuffy?

P: Uh yeah, kind of. He's just been snorting and sniffing and um I don't think he knows how to blow his nose yet. But he's like clearing his throat, so I think he's he's a little bit stuffy.

D: Okay.

P: But he hasn't complained about difficulty with breathing or like, he's been, like he sleeps with his mouth closed. So I think he he should be able to breathe OK.

D: OK, good, so you said no shortness of breath or trouble breathing. Has he had any coughs?

P: Kind of. In the morning, so I I see that whenever he wakes up in the morning, he just has to like clear his throat a lot and like cough and then um gets better.

D: OK, OK. Is he bringing up phlegm when he coughs?

P: Um, a little bit. 

D: What colour is it? 

P: It's the same stuff that comes out of his nose.

D: OK yeah, so no blood or pus?

P: No, no.

D: No? OK. Have you, do you think he's lost his like sense of smell or taste? 

P: Uhh no.

D: No? OK. Any changes in his vision or hearing?

P: Um I don't think so. 

D: No? Did like, um, have you noticed any discharge from his eyes?

P: No, no. Sometimes he does have that, but no, not in the past two weeks.

D: OK so his like eyelids aren't swollen or his eyes aren't red?

P: No, no, no. 

D: No? OK. And does he, have you noticed any swelling in his, either like face, neck, like belly area, or his limbs?

P: No, no I haven't. It's just his nose is like a little bit red.

D: OK. 

P: And uh yeah, he's just he's just itching all the time, just itching his nose, itching his um ears, yeah but no, no swelling. 

D: No swelling. Have you noticed any rashes on him?

P: No, I checked yesterday night very carefully.

D: OK, good. Any weight loss?

P: No, he's been gaining weight so um good that he's been eating well. 

D: Yeah, that's good. Any fevers or chills?

P: No.

D: No, does he look like he's like excessively tired?

P: He's a little bit fatigued because of the sneezing and the, and the runny nose. You know, he's not going out to play as much.

D: Mhmm.

P: Um but it's not, you know he's still, he's still cheerful. He's not irritable or anything. 

D: OK, OK. Um and then have you noticed that he's like, taking in like, rapid breaths?

P: No, no, his breathing has been good.

D: OK. How about his bowel movements? Have those been normal? 

P: Yeah.

D: Yeah OK, any nausea or vomiting?

P: No.

D: Um, how about his urine?

P: No, no problems there. 

D: OK, how about like dizziness or fainting spells?

P: No, no, no. I didn't notice anything like that.

D: No? Any confusion that you noticed?

P: No. 

D: Headaches?

P: No. 

D: No, OK. Um has he been like excessively itching anywhere?

P: Um just his uh, just his nose and I think his like, I think his mouth is itchy too, 'cause he keeps doing this thing with his tongue just kind of, I don't know, just kind of like
itching the top of his mouth with his tongue or something.

D: OK.

P: Um yeah just like his face is itchy.

D: Hmm, OK. Um, has he come into any contact with sick people recently?

P: Um, I don't, maybe. So, two weeks ago he was playing outside, um and I know that he, he does, his symptoms do get worse when he's outside, so I don't know, maybe.

D: OK.

P: He was playing with uh, with his brother but then this other kid from the neighbourhood also came around.

D: OK, OK. How about um travel to anywhere?

P: No, we've just been staying at home.

D: OK, OK good. Um is he an otherwise healthy kid at the moment?

P: Yeah, yeah, he's an, he's a healthy kid.

D: OK, um any complications when you were pregnant with him?

P: No. 

D: No? Um how about at birth?

P: No, no complications.
 
D: OK. Did he need to be hospitalized after birth for any reason?

P: No. 

D: Any surgeries?

P: No.

D: Um, any allergies?

P: Um I don't think so. I know he's not.

D: No? He's never been diagnosed with like eczema or asthma? 

P: Oh he's, he's had eczema. He had it.

D: OK. 

P: Yeah, comes and goes.

D: His eczema comes and goes?

P: Hmm. 

D: OK, um is he on any medications?

P: No. 

D: No? Even for his eczema?

P: It's pretty mild.

D: OK. Um has, have you ever like given him um Reactine or like any of the, those anti allergy medications in the past? 

P: I've tried the, uh, yeah, the ones over the counter, um, they do help. Um, I tried it this time, but uh it didn't do much.

D: OK. OK. And, I was gonna ask you something else. Um, his symptoms, like the sneezing and the, and the runny nose, like has he experienced this before?

P: Oh yeah.

D: OK.

P: It usually gets worse um uh I guess like around this time, uh I can tell when spring is coming up. Um, it gets pretty bad, but he always has a runny nose um and he sneezes sometimes here and there.

D: OK, and you mentioned this has been going on for more than four days this time around? 

P: It's been, it's been going on for the past uh two weeks. 

D: OK. OK, and is it like um impairing his like daily activities or like his ability to um like, sleep?  

P: Uh it does affect his sleep sometimes he doesn't like um, just the itching really bothers him.

D: Mhmm.

P: So he can't uh, he finds it hard to fall asleep. That's like, I usually, that's when I give him the the medications. To help him fall asleep. 

D: OK. OK. And uh is he up to date with all his immunizations?

P: Yeah. 

D: OK. Any family history of asthma, eczema, or something called allergic rhinitis?

P: Uh I have asthma. 

D: OK. And is your asthma severe?

P: Uh no, it's it's pretty well controlled. I used to, actually, I used to have asthma as a child. 

D: OK, I see.

P: It's pretty well controlled right now. I don't even need medications.

D: OK, OK.

P: I remember I used to, I used to get allergies as well as a child.

D: Oh I see. 

P: But very similar, lots of sneezing and yeah.

D: Mhmm, alright. Were you ever, did you ever take like an allergy test?

P: No. I didn't think about it, I just never, like my my my parents didn't take me to get that testing done.

D: OK, how about your son? Has he been allergy tested?

P: No, but I feel like he probably should.

D: Yeah, OK. And then, does anyone at home smoke?

P: No. 

D: No, OK. Um do you have any, like old carpets, dust, mold, or asbestos at your place?

P: Uh we've got all of, we got our carpets uh removed uh two years ago. That's actually helped uh with his symptoms. Uh and I know, we tried it, we removed the curtains as well and we've used blinds. So yeah. 

D: OK.

P: And I don't think so, I don't think there's any spores or things like that.

D: OK, good. Um, is he an otherwise healthy child like developmental wise, like he's growing, gaining weight OK, like he's, his motor skills and like social behaviours are all up to par with his peers?

P: Oh yeah he's doing great.

D: OK OK good um those are all the questions I had for you today. Did you have any questions of your own?

P: No.

D: No, OK. So for him um it sounds more in keeping with something called allergic rhinitis than an infection, but because his symptoms do overlap with that of Covid,  we'll probably get him a swab anyways, and those results should come back in 24 to 48 hours. In the meantime, rhinitis is, allergic rhinitis is caused by allergies to certain things, so we can get him allergy tested um and that will give us a better understanding of like what his triggers are and the way to treat that is to avoid those triggers, those allergens. And if his symptoms are persistent, um we will prescribe him also like an intranasal corticosteroid. Um and there are like, there are like second line treatments as well, like antihistamines and leukotriene, like leukotriene receptor antagonists, but those are like second line. We'll we'll see how he does with the inhaled corticosteroids at first. How does that sound?

P: Sounds great.

D: OK, great.

P: Thank you.

D: No problem.