• The diagnosis of allergic rhinitis relies mainly on the clinical history, physical exam & diagnostic tests

• Infection
  • Acute
  • Chronic
• Irritant rhinitis
  • Physical
  • Chemical
  • Radiation
• Hyperesthetic non-infectious rhinitis
  • Combined type (nasal hypersensitivity)
    • Allergic (perennial, seasonal)
    • Nonallergic (vasomotor or idiopathic rhinitis, rhinitis with eosinophilia syndrome)
    • Rhinorrhea type (gustatory rhinitis, cold inhalation rhinitis, senile rhinitis)
    • Congestive type (medicament rhinitis, psychogenic rhinitis, pregnant rhinopathia, hormonal rhinitis and cold rhinitis)
• Others
  • Atopic rhinitis
  • Specific granulomatous rhinitis

• The following factors are considered when evaluating a patient’s response to treatment:
  • Symptom score
  • Visual analogue scales (VAS)
  • Measures of nasal obstruction (eg peak nasal inspiratory flow, acoustic rhinometry, rhinomanometry)
  • Allergic Rhinitis & its Impact on Asthma (ARIA) severity classification
  • Quality of Life (QOL) result
  • Itemized scoring
  • Symptom-medication scoring

• A clinical approach used to diagnose & classify patients based on disease severity, as well as a tool to evaluate symptom control after initiation of treatment strategies by using Information & Communications Technology (ICT) tools & a clinical decision support system (CDSS), based on ARIA guidelines
• Suggests that everyday monitoring with VAS can potentially help a patient to take control of symptoms

• An electronic-based tool used to monitor the course of allergic rhinitis especially the effectiveness of therapy
• It is used everyday for better symptom control
• A low VAS measurement with the establishment of treatment, shows an amount of improvement, as indicated in Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) as well as in terms of work efficiency
  • VAS score of 2 or <10 means well-controlled allergic rhinitis
• A high VAS measurement (>50 mm) shows no effect in symptom relief

• E-allergy screening
  • An online procedure consisting of questionnaires for early detection of the presence of allergy & asthma
  • Results are based on the calculated risk for certain allergic conditions (eg allergic rhinitis, asthma, atopic dermatitis, insect allergies)
  • Used as support for an allergic disease diagnosis & should not replace a physician’s evaluation
• MASK Aerobiology
  • An IOS/Android app that is VAS-patterned which measures control of rhinitis
• Control of Allergic Rhinitis & Asthma Test (CARAT)
  • A questionnaire used for the simultaneous daily assessment of disease control of both allergic rhinitis & asthma
• RhinAsthma Patient Perspective (RAPP)
  • Provides assessment of the QOL of asthma & rhinitis patients in relation to health issues by means of a questionnaire
  • The score is the sum of the answers for the 8 questions provided
    • 8: No effect on QOL
    • 40: With heavy effect on QOL

• A technology-based tool that helps in monitoring control of the disease to be able to formulate an efficient medical management plan
• Should consist of quality guidelines or algorithms that would help in deciding whether a step-up or a step-down in the treatment is necessary
• Suggests a standard guide for therapy that is based on a physician’s view during clinic visits prior to the pollen season
• Used in combination with e-allergy screening, MASK aerobiology or CARAT

• Assessment will be based on the following:
  • Patient's symptomatology
  • Patient's exposure to allergens
  • Visual analogue scales (VAS)

Symptom duration of allergic rhinitis is classified into the following:

Intermittent

• Symptoms occur <4 days/week or symptoms last for <4 consecutive week/year

Persistent

• Symptoms occur >4 days/week & last for >4 consecutive week/year

Symptom severity of allergic rhinitis is classified into the following:

Mild

• Normal sleep
• Normal functioning at work & school
• Normal conduct of routine & leisure activities
• No bothersome symptoms

Moderate-Severe

• Sleep disturbance
• Problems w/ functioning at work or at school
• Impairment of routine & leisure activities
• Bothersome symptoms

Patterns of exposure to allergens:

Seasonal

• Dependent on a specific season

Perennial

• Year-round allergen exposure & usually present in everyday environment

Episodic

• Patient is exposed to allergens not normally encountered in daily activities

• A family or personal history of allergy & related conditions should be elicited
  
  • Asthma or eczema
  • Atopic dermatitis
  • Rhinitis
  • Chronic sinusitis
  • Food allergy
  • Drug sensitivity [eg Aspirin/Non-steroidal anti-inflammatory drugs (NSAIDs)]
• Evaluate for asthma especially in patients diagnosed with severe &/or persistent allergic rhinitis
  
  • Asthmatic patients most likely (≥80%) suffer from allergic rhinitis
• Determine onset patterns of symptoms including triggers & seasonality, & relief with certain treatments
• History of exposure to allergens must be scrutinized
  
  • Occupational, home & school exposures
  • Exposure to passive or active smoking

• Complete examination of all systems potentially affected by allergies should be performed in patients with history of rhinitis

Nasal Examination

• Preferably through endoscopy performed by specialist
• May reveal the following:
  
  • Swollen nasal turbinates
  • Rhinorrhea w/ clear, cloudy or colored discharge 
• Patient should be referred to a specialist if findings are more consistent w/ a structural etiology than rhinitis (eg tumors, nasal polyps, septal deviation)

Other physical findings include:

• Conjunctivitis
• Allergic “shiners” (dark circles under the eyes resulting from venous stasis)
• Lower eyelid creases
• Nasal crease
• Periorbital edema
• Cobblestoning of the pharynx

Allergy Testing

• Considered as the results would help in the management of the disease
• Recommend expert referral

Skin Tests & Radioallergosorbent Test (RAST)/Automated Immunoassay Systems

• Used to differentiate allergic from nonallergic rhinitis or to determine specific allergens causing allergic rhinitis
• Skin test is preferred due to its better sensitivity, faster results, & lesser cost

Nasal Smear for Eosinophils

• Eosinophils may be seen in both allergic & nonallergic rhinitis
• Presence of eosinophilia predicts a good response to topical nasal corticosteroid medication
• May be performed when allergic symptoms are present