Atopy or allergic diseases have almost similar manifestations that result in health care professionals coming up with multiple diagnoses. A case in point is in the scenario of John, a 19-year-old college football player that has clinical manifestations like sneezing, itchy eyes and nasal congestion, which worsens at night. In this instance, John’s condition perfectly befits the diseases that have multiple diagnoses. In essence, this discussion aims at establishing the possible conditions that John might be suffering from and validating their likelihood as the true diagnosis.

To begin with, John’s signs and symptoms match the description of a person with the diagnosis of allergic rhinitis. Buttaro, Trybulski, Polgar-Bailey, and Sandberg-Cook, (2013) are of the opinion that allergic rhinitis accounts for approximately 50 million persons in the USA. In allergic rhinitis, one presents clinically with manifestations such as sneezing, itchy eyes and nasal congestion. Moreover, John has a positive history of atopic conditions, namely asthma, eczema and allergies to pollen, which makes him a risk factor for allergic rhinitis. That is the case given that these conditions are responsible for the first immune response that releases Ig E, whose release in the subsequent exposure is amplified. As such, the hallmark of the pathophysiology of allergic rhinitis is the heightened release of the Ig E upon exposure to the allergens. Consequently, one starts experiencing nasal congestion, itchiness of the eyes, sneezing and runny nose due to the overproduction the inflammatory mediators, especially Ig E (Copstead-Kirkhorn & Banasik, 2014). Given the history and the signs and symptoms, that John presents with it is beyond doubt that he is likely suffering from allergic rhinitis.

Another possible diagnosis for John’s condition is infectious rhinitis. Infectious rhinitis is common in persons that have had exposure to infectious agents such as the viruses (rhinoviruses and coronavirus) and bacteria. Rhinoviruses lead to the development of viral rhinitis (colds) that is more common among children as compared to adults. Its frequency within a year in children is between 6 and 21 in the USA (Bluestone, Simons, & Healy, 2014). The viral rhinitis starts soon after the entry of the rhinovirus in the upper respiratory airway where the temperatures are favorable for its existence. Upon the colonization of the upper respiratory tract, the body evokes an immune response that causes a release of inflammatory mediators such as interleukins, prostaglandins and tumor necrosis factor that constitute the rhinorrhea diagnosis. On the contrary, the bacterial cause of rhinitis is only evident soon after the development of a secondary infection like sinusitis. It develops after an allergic or viral swelling of the nose that affects the sinus drainage. The impairment of the drainage results in trapping of microorganisms, which leads to this type of rhinitis. The signs of infectious rhinitis are fever, purulent sinus discharge and nasal congestion (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2013). In comparison with John’s case, infectious rhinitis is not a befitting diagnosis because he does not have a marked increase in temperature and purulent drainage. Evidently, these instances are proof enough that John is not experiencing an infectious type of rhinitis.

Lastly, non-allergic rhinitis is also a differential diagnosis for John’s condition. The epidemiologic distribution of this disease shows that its prevalence rate is higher after the age of 20 and less common in children. The non-allergic rhinitis begins soon after exposure to an irritant such as chemical, strong odors, weather-related alterations like cold weather and cigarette smoke. In the presence of these irritants, the body evokes a non-Ig E-mediated immune response that results in manifestations that point out to this diagnosis. Such signs and symptoms include but not limited to nasal stuffiness, pain/pressure and sensitivity to post-nasal drip. Less common manifestations are nasal itching and sneezing (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2013). In comparison to John’s sign and symptoms as well as history, this diagnosis is less likely to be the correct one. That is the case because John exhibits sneezing and nasal itching as principle manifestations while in non-allergic rhinitis the two symptoms are rare. Moreover, from John’s history of asthma and allergy to pollen grains, it is less likely that he develops the non-allergic type of rhinitis. From the case scenario, he is mainly at risk of the allergic type of rhinitis given that non-allergic rhinitis would require an irritant to develop, which is not evident in this instance. As such, it is beyond question that non-allergic rhinitis cannot be a befitting diagnosis for John.

In closure, this paper aimed at determining the likely diagnoses for John’s condition. Indeed, he is a candidate for allergic rhinitis because the description of the case scenario is reminiscent for a person with allergic rhinitis. However, John could be having a diagnosis of non-allergic rhinitis or infectious rhinitis. As such, health care professionals must carry out further tests to validate which of the three is the most likely diagnosis. Failure to do so, however, can only result in treating John for the wrong diagnosis, which is unacceptable in the contemporary medical world. Thus, medical personnel can only avert this challenge by taking their time to evaluate all the possible diagnoses of the patient and deciding on the most likely of them all.


Bluestone, C. D., Simons, J. P., &Healy, G. B. (2014). Bluestone and Stool’s pediatric otolaryngology.

Buttaro, T., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. (2013). Primary care: A collaborative practice (4th ed.). St. Louis, Mo.: Elsevier Health Sciences.

Copstead-Kirkhorn, L., & Banasik, J. L., (2014). Pathophysiology (5th ed.).