Who Should Be Suspected?
Typical patient presentation includes nasal irritation, sneezing, rhinorrhea, and nasal blockage, symptoms that may be seasonal or perennial. The dominant symptoms may differ from one patient to another. There is also a wide individual variation in terms of tolerability of nasal symptoms. Conjunctival symptoms of itching and increase in tear fluid are also very common in association with allergic rhinitis.
A new classification system of AR was designed based on frequency and severity of symptoms. Frequency (intermittent (<4 days/week or <4 consecutive weeks) versus persistent (4 days/week and >4 consecutive weeks). Severity of AR can be classified as mild, moderate to severe based on whether AR symptoms result in impairment of daily activities and degree of symptoms.
Diagnostic Findings
The diagnosis of rhinitis in a patient complaining of upper airway problems consists of obtaining a detailed history and performing physical examination supplemented by critical tests.
Hematology: High numbers indicate that atopy is present. The usefulness of eosinophilia and determination of total IgE are limited in the diagnosis of allergic rhinitis, because to some degree, they are dependent on the size of the organ.
Allergen-specific testing: The use of diagnostic testing to identify culprit allergens has been associated with improved patient outcomes.
Skin testing: When carefully performed by well-trained individual, immediate hypersensitive skin testing (skin prick tests [SPTs]) is a safe way to identify the presence of allergen-specific IgE. Skin testing is useful among patients with
Unclear diagnosis based on the history and physical examination
Poorly controlled symptoms, such as persistent nasal symptoms and/or an inadequate clinical response to nasal glucocorticoids
Coexisting persistent asthma and/or recurrent sinusitis/otitis
Occupational rhinitis
Serum tests for allergy: Serum immunoassays for specific IgE antibodies are better alternates to SPTs for screening. These specific IgE tests are useful for testing-specific allergens that are not available for skin tests or when skin tests cannot be performed because a patient is taking treatment (e.g., histamine) that suppresses the cutaneous response.
