Summary
Definition
History and exam
Key diagnostic factors
- sneezing
- nasal pruritus
Other diagnostic factors
- palate, throat, ear, and eye itching
- eye redness, puffiness, and watery discharge
- fatigue and irritability
- nasal congestion
- rhinorrhea
- 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
- other atopic conditions or family history of atopy
- age <20 years
- exposure to aeroallergens (pollen, molds, house dust mites, pollution)
- exposure to animal dander
- ethnicity
- positive allergen skin-prick tests
Diagnostic tests
1st tests to order
- therapeutic trial of antihistamine or intranasal corticosteroid
Tests to consider
- allergen skin-prick testing
- in vitro specific IgE determination
Treatment algorithm
mild or intermittent symptoms
persistent and moderate to severe symptoms
usual therapy ineffective or poorly tolerated
Contributors
Authors
Gary C. Steven, MD, PhD, CPI, FAAAAI, FACAAI, FAPCR
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
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 pediatric patients. He is a member of the Joint Task Force on Practice Parameters Workgroup on the Allergic Rhinitis Practice Parameter.
Acknowledgements
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: AstraZeneca; 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 AstraZeneca.
Peer reviewers
Mark Davis-Lorton, MD
Clinical Immunology Coordinator
Division of Rheumatology, Immunology and Allergy
Winthrop-University Hospital
Mineola
NY
Disclosures
MDL declares that he has no competing interests.
Glenis Scadding, MD
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, Grupo 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.
Differentials
- Nonallergic rhinitis
- Acute sinusitis
- Chronic sinusitis
More DifferentialsGuidelines
- Clinical practice guideline: immunotherapy for inhalant allergy
- Australasian guidelines for allergic rhinitis 2022
More GuidelinesPatient information
Hay fever
Hay fever: avoiding pollen and mold
More Patient information
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer