Summary
Definition
History and exam
Other diagnostic factors
- palate, throat, ear, and eye itching
- eye redness, puffiness, and watery discharge
- fatigue and irritability
- nasal congestion
- rhinorrhoea
- allergic shiners
- conjunctival injection
- ocular mucoid discharge
- nasal crease
- pale nasal mucosa
- swelling of the nasal mucosa and turbinates
- abundant clear nasal secretions
- Dennie-Morgan lines (creases present under the lower eyelids)
Risk factors
- family history of atopy
- age <20 years
- positive allergen skin-prick tests
- inadequate exposure to animals and other micro-organism-rich environments in early life
- Western lifestyle
- ethnicity
- environmental pollution
- exposure to indoor allergens such as animal dander and dust mites
- heavy maternal smoking (20 or more cigarettes/day during the first year of life)
- early introduction of foods or formula
- breastfeeding
- presence of other atopic conditions (eczema, food allergies, wheezing/asthma)
Diagnostic investigations
1st investigations to order
- therapeutic trial of antihistamine or intranasal corticosteroid
Investigations to consider
- allergen skin-prick testing
- in vitro specific IgE determination
Treatment algorithm
Contributors
Authors
Regent
American College of Allergy, Asthma & Immunology
Medical Director
American Academy of Allergy, Asthma & Immunology Registry
Assistant Clinical Professor of Medicine
Medical College of Wisconsin
Adjunct Clinical Instructor
College of Nursing
University of Wisconsin-Milwaukee
Executive Director
Fight Asthma Milwaukee Allies
Allergy, Asthma & Sinus Center
Milwaukee
WI
Disclosures
GCS has taken part in sponsored research for the ALK clinical trial of the house dust mite SLIT tablet for use in paediatric patients. He is a member of the Joint Task Force on Practice Parameters Workgroup on the Allergic Rhinitis Practice Parameter.
Dr Gary C. Steven would like to gratefully acknowledge Dr Alexander Greiner, a previous contributor to this topic.
Disclosures
AG has received grant/research support from: Astra Zeneca; Boehringer Ingelheim; Cephalon Circassia Ltd; Clement Clarke Cytos biotechnology; GlaxoSmithKline; Glenmark Specialty, S.A.; Hoffman-LaRoche/Genentech; HRA/Novartis; Janssen Research & Development; Kalypsys , Inc.; Lupin; Merck; Mylan Pharmaceuticals, Inc.; Nestle (Nestec Ltd); Novartis Ono Pharmaceutical Co., Ltd.; Perrigo; Rigel Pharmaceuticals, Inc.; Roxane Laboratories Inc.; Shionogi Inc.; Sunovion TEVA Branded Pharmaceutical Products; UBC (United Biosource Corporation)/Amgen Pharmaceuticals; and sponsorship for pharmaceutical trials from Allergen Research Corporation/Aimmune Therapeutics, Inc. and Astra Zeneca.
Peer reviewers
Clinical Immunology Coordinator
Division of Rheumatology, Immunology and Allergy
Winthrop-University Hospital
Mineola
NY
Disclosures
MDL declares that he has no competing interests.
Consultant Allergist/Rhinologist
Allergy & Rhinology Department
Royal National Throat, Nose and Ear Hospital
London
UK
Disclosures
GS is a consultant/advisory board member for ALK, Britannia Pharmaceuticals, CMP Therapeutics, Groupo Uriach, GSK, Merck, Sanofi-Aventis, Schering Plough, and UCB. She has received research funds from ALK, GSK, UCB, and Schering Plough. She has given talks for ALK, GSK, Merck, Schering Plough, and UCB and has co-written articles for Schering Plough and GSK.
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