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Clinical Presentation
The major symptoms of
allergic rhinitis include nasal itching, watery rhinorrhea, nasal obstruction
or congestion, sneezing, and postnasal drainage.
Rhinitis - Allergic (Initial Assessment 1)Other symptoms include headache, conjunctival symptoms, eye pruritus, impaired smell, morning cough, and sleep problems or excessive daytime sleepiness or sleep-disordered breathing or obstructive sleep apnea.
The above symptoms can reverse spontaneously with or without treatment.
History
On clinical history, a family or personal history of
allergy and related conditions should be elicited which includes asthma or
eczema, atopic dermatitis, rhinitis, chronic sinusitis, food allergy, and drug
sensitivity (Aspirin or Nonsteroidal Anti-Inflammatory Drugs [NSAIDs]).
Evaluate for allergic asthma, especially in patients
diagnosed with severe and/or persistent allergic rhinitis. Asthmatic patients
most likely (≥80%) suffer from allergic rhinitis. Please refer to Asthma disease management
chart for further information on diagnosis and evaluation.
Determine onset patterns of symptoms including
triggers and seasonality, and relief with certain treatments. Any history of
exposure to allergens must be scrutinized including occupational, home, and school
exposures and exposure to passive or active smoking.
Physical Examination
A complete examination of all systems potentially
affected by allergies should be performed in patients with a history of
rhinitis.
A nasal examination is preferably done through an endoscopy
performed by a specialist. It may reveal swollen nasal turbinates, or rhinorrhea
with clear, watery, cloudy, or colored discharge. Colored discharge may
indicate a comorbid condition with allergic rhinitis.
Rhinitis - Allergic (Initial Assessment 2)Patients should be referred to a specialist if findings are more consistent with structural etiology rather than rhinitis (eg tumors, nasal polyps, septal deviation).
Other physical examination findings include conjunctivitis, allergic “shiners” (dark circles under the eyes resulting from venous stasis), lower eyelid creases (also called Dennie-Morgan lines), nasal crease (also known as the "allergic salute"), periorbital edema, and cobblestoning of the pharynx. Some patients may present with a geographic tongue.
Diagnosis or Diagnostic Criteria
Diagnosis relies mainly on clinical history, physical examination, and diagnostic tests.