Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- nasal congestion
- post-nasal drainage
- rhinorrhoea
- sore throat
Other diagnostic factors
- ear plugging
- sinus headaches
- postural change triggers
- absence of fever
- sneezing
- purulent discharge
- bilateral symptoms
- sinus pain
Risk factors
- symptom onset age >35
- no seasonal symptoms
- no symptom exacerbation by cats
- exposure to fragrance
- exposure to smoke (e.g., wood, tobacco)
- exposure to hairspray
- exposure to pot pourris
- changes in temperature
- barometric changes
- no family history of allergies
- high oestrogen state
- beta-blocker use
- intranasal drug abuse
Diagnostic investigations
1st investigations to order
- allergy prick skin tests
- serological specific IgE testing
Investigations to consider
- nasal eosinophil smear
- sinus computed tomography
- nasal endoscopy
- nasal provocation test
Treatment algorithm
congestion predominant
rhinorrhoea predominant
Contributors
Authors
Jonathan A. Bernstein, MD
Professor of Clinical Medicine
Department of Internal Medicine
Division of Immunology/Allergy Section
University of Cincinnati College of Medicine
Cincinnati
OH
Disclosures
JAB has acted as a consultant for Inflamax, MEDA, GSK, and ATL, and serves on a medical safety board for HAL Allergy; is a principle investigator or sub-principle investigator for over 30 pharmaceutical companies; has an investigator-initiated research project from Shire; is a protocol chair for a U44 clinical trial funded by NAIAD; is a speaker for AZ, Shire, and CSL Behring; and is an author of a number of references cited in this topic.
Acknowledgements
Professor Bernstein would like to gratefully acknowledge Dr Chris Codispoti, a previous contributor to this topic.
Disclosures
CC declares that he has no competing interests.
Peer reviewers
Elisabeth E. Adderson, MD
Associate Member
St. Jude Faculty Director
Pediatric Infectious Diseases Fellowship Program
Memphis
TN
Disclosures
EEA declares that she has no competing interests.
Ozgur Yigit, MD
Chief
ENT Department
Istanbul Training and Research Hospital
Istanbul
Turkey
Disclosures
OY declares that he has no competing interests.
Differentials
- Allergic rhinitis (seasonal, perennial, mixed)
- Nasal polyposis
- Deviated septum
More DifferentialsGuidelines
- EAACI position paper on non-allergic rhinitis
- BSACI guidelines for the diagnosis and management of allergic and non-allergic rhinitis
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