Last reviewed: 6 Apr 2021
Last updated: 30 Jan 2019



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


Professor of Clinical Medicine

Department of Internal Medicine

Division of Immunology/Allergy Section

University of Cincinnati College of Medicine




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.

Professor Bernstein would like to gratefully acknowledge Dr Chris Codispoti, a previous contributor to this topic.


CC declares that he has no competing interests.

Peer reviewersVIEW ALL

Associate Member

St. Jude Faculty Director

Pediatric Infectious Diseases Fellowship Program




EEA declares that she has no competing interests.


ENT Department

Istanbul Training and Research Hospital




OY declares that he has no competing interests.

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