• 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

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/NSAID)
• 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 exam of all systems potentially affected by allergies should be performed in patients w/ history of rhinitis

Nasal Exam

• 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