![]() ![]() ![]() Indication: preferred over blood tests as they are more sensitive.Testing for food allergens is not routinely recommended. Testing for aeroallergens is recommended in all patients with features consistent with allergic rhinitis. Įpistaxis, unilateral rhinorrhea or nasal blockage, severe headache, or anosmia are atypical for allergic rhinitis and should prompt further workup for an alternative diagnosis. Īllergic rhinitis is primarily a clinical diagnosis in patients presenting with characteristic clinical features (i.e., nasal congestion, rhinorrhea, itchy nose, sneezing) that are triggered by seasonal, perennial, or episodic exposure to allergens. Consider in cases of diagnostic uncertainty (e.g., to rule out sinonasal disorders).Additional diagnostic modalities (e.g., imaging and nasal endoscopy).To confirm the diagnosis in the following situations :.To identify the causative allergen in all patients with features consistent with allergic rhinitis.Coexisting conditions (e.g., asthma, atopic dermatitis, otitis media).Obtain a detailed clinical history identifying:. ![]() Nasal polyps are pale, soft, mobile, insensitive, and do not decrease in size following therapy with nasal decongestants. Hypertrophic turbinates are pink or violaceous, hard, sensitive to probing, immobile, and shrink with nasal decongestant therapy. Chronic allergic rhinitis can predispose the patient to recurrent sinusitis and/or otitis media.Allergic nasal crease: a transverse hyperpigmented or hypopigmented line that is seen at the junction of the lower third and the middle third of the nasal bridge, which is the natural crease formed when the nose is pushed upwards by the allergic salute.Allergic salute: a habit of wiping the nose with a transverse or upward movement of the hand.Allergic shiners: hyperpigmentation and edema of the lower eyelid as a result of venous congestion.Cobblestone appearance of the posterior pharyngeal wall.Nasal polyps are seen in 25–30% of patients with chronic allergic rhinitis.Pale, boggy nasal mucosa with hypertrophic turbinates.Recurrent episodes of sneezing, nasal congestion, rhinorrhea, and postnasal drip.Allergen immunotherapy may be considered if initial treatment does not provide adequate symptom relief. Initial management involves allergen and irritant avoidance and pharmacotherapy with intranasal corticosteroids or oral or intranasal antihistamines. Allergen testing helps determine the causative allergen and may also be used to confirm the diagnosis if there is clinical uncertainty. Allergic rhinitis is typically diagnosed based on clinical features. Exacerbation of allergic rhinitis symptoms may occur in certain seasons or with exposure to certain allergens. Clinical manifestations of allergic rhinitis include nasal congestion, rhinorrhea, sneezing, and postnasal drip. It is the most common form of rhinitis and is associated with other allergic conditions such as atopic dermatitis and asthma. Allergic rhinitis is an acute or chronic inflammation of the nasal mucosa caused by a type 1 hypersensitivity reaction to an inhaled allergen (e.g., dust, animal dander, mold spores, plant pollen).
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