Consult the medical resource doctors trust

UpToDate is one of the most respected medical information resources in the world, used by over 360,000 doctors and thousands of patients to find answers to medical questions.

  • Content written by a faculty of over 4,000 physicians from leading medical institutions
  • Unbiased: free of advertising or pharmaceutical funding
  • Evidence-based treatment recommendations
  • Continuously updated to incorporate new medical findings

Diagnosis of allergic rhinitis (rhinosinusitis)

INTRODUCTION

Rhinitis is defined as the occurrence of annoying nasal symptoms including discharge, itching, sneezing, congestion, and pressure. Many cases can be classified into a specific syndrome, each with its own causes and treatments. The rhinitis syndromes are principally recognized by clinical patterns. (See "An overview of rhinitis".)

Allergic rhinitis, one of the rhinitis syndromes, is associated with a symptom complex characterized by paroxysms of sneezing, rhinorrhea, nasal obstruction, and itching of the eyes, nose, and palate. It is also frequently associated with postnasal drip, cough, irritability, and fatigue [1-3].

  • Seasonal allergic rhinitis refers to allergic rhinitis symptoms that typically occur at a particular time of the year
  • Perennial allergic rhinitis refers to allergic rhinitis symptoms that occur year round

Nasal inflammation associated with allergic rhinitis can also cause obstruction of the sinus osteomeatal complex, thereby predisposing to bacterial infection of the sinuses. This process accounts for many cases of acute and chronic bacterial sinusitis. Symptoms of bacterial sinusitis may include nasal congestion, purulent rhinorrhea or postnasal drip, facial or dental pain, and cough. Purulent rhinorrhea, purulent postnasal drip, or pain in a maxillary tooth and persistent cough in children are the most useful predictors of bacterial sinusitis. However, no single symptom has a high degree of sensitivity or specificity in discriminating bacterial sinusitis from allergic or viral rhinitis [4,5].

Some investigators prefer the term rhinosinusitis to the separate terms rhinitis and sinusitis. This is because, as just mentioned, rhinitis and sinusitis frequently occur together; rhinitis commonly leads to sinusitis; nasal symptoms are common with sinusitis; and the nose and sinus mucosa are contiguous.
To continue reading this article you need to subscribe.

Read the rest of this article and others like it

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) ©2009 UpToDate, Inc.
References Top
  1. Dykewicz, MS, Fineman, S, Skoner, DP, et al. Diagnosis and management of rhinitis: Complete guidelines of the Joint Task Force on Practice Paramaters in Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 1998; 81:478.
  2. Ng, MLS, Wardlow, RS, Chrishanthan, N, et al. Preliminary criteria for the definition of allergic rhinitis: A systemic evaluation of clinical parameters in a disease cohort (I). Clin Exp Allergy 2000; 30:1314.
  3. Ng, MLS, Lardlow, RS, Chrishanthan, N, et al. Preliminary criteria for the definition of allergic rhinitis: A systemic evaluation of clinical parameters in a disease cohort (II). Clin Exp Allergy 2000; 30:1417.
  4. Spector, SL, Bernstein, IL, Li, JT, et al. Parameters for the diagnosis and management of sinusitis. J Allergy Clin Immunol 1998; 102:S107.
  5. Berman, SZ, Mathison, DA, Stevenson, DD, et al. Maxillary sinusitis and bronchial asthma: Correlation of roentgenograms, cultures, and thermograms. J Allergy Clin Immunol 1974; 53:311.
  6. Wight, RG, Jones, AS, Beckingham, E, et al. A double blind comparison of intranasal budesonide 400 micrograms and 800 micrograms in perennial rhinitis. Clin Otolaryngol 1992; 17:354.
  7. Banov, CH, Lieberman, P. Efficacy of azelastine nasal spray in the treatment of vasomotor (perennial nonallergic) rhinitis. Ann Allergy Asthma Immunol 2001; 86:28.
  8. Gendo, K, Larson, EB. Evidence-based diagnostic strategies for evaluating suspected allergic rhinitis. Ann Intern Med 2004; 140:278.
  9. Bousquet, J, van Cauwenberge P, Khaltaev N. Allergic rhinitis and its impact on asthma: ARIA Workshop Report. J Allergy Clin Immunol 2001;108:S147.
  10. White, P, Smith, H, Baker, N, et al. Symptom control in patients with hay fever in UK general practice: how well are we doing and is there a need for allergen immunotherapy?. Clin Exp Allergy 1998; 28:266.
  11. Szeinbach, SL, Williams, PB, Kucukarslan, S, Elhefni, H. Influence of patient care provider on patient health outcomes in allergic rhinitis. Ann Allergy Asthma Immunol 2005; 95:167.
  12. Joint Task Force on Practice Parameters. Allergen immunotherapy: a practice parameter. American Academy of Allergy, Asthma and Immunology. American College of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 2003; 90 (1 Suppl 1):1.
  13. Measurement of specific and nonspecific IgG4 levels as diagnostic and prognostic tests for clinical allergy. AAAI Board of Directors. J Allergy Clin Immunol 1995; 95:652.
  14. Meltzer, EO, Hamilos, DL, Hadley, JA, et al. Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol 2004; 114:155.
  15. Craig, TJ, Teets, S, Lehman, EB, et al. Nasal congestion secondary to allergic rhinitis as a cause of sleep disturbance and daytime fatigue and the response to topical nasal corticosteroids. J Allergy Clin Immunol 1998; 101:633.
  16. Settipane, RA. Rhinitis: a dose of epidemiological reality. Allergy Asthma Proc 2003; 24:147.
  17. Ramey, JT, Bailen, E, Lockey, RF. Rhinitis medicamentosa. J Investig Allergol Clin Immunol 2006; 16:148.
  18. Passali, D, Salerni, L, Passali, GC, et al. Nasal decongestants in the treatment of chronic nasal obstruction: efficacy and safety of use. Expert Opin Drug Saf 2006; 5:783.
  19. Graf, P. Rhinitis medicamentosa: a review of causes and treatment. Treat Respir Med 2005; 4:21.
  20. van Rijswijk, JB, Blom, HM, Fokkens, WJ. Idiopathic rhinitis, the ongoing quest. Allergy 2005; 60:1471.
  21. Jacobs, RL, Freedman, PM, Boswell, RN. Nonallergic rhinitis with eosinophilia (NARES syndrome). Clinical and immunologic presentation. J Allergy Clin Immunol 1981; 67:253.
  22. Settipane, RA, Lieberman, P. Update on nonallergic rhinitis. Ann Allergy Asthma Immunol 2001; 86:494.
white circle LOG IN
white circle DEMO