Materiały źródłowe

• #1 Allergic rhinitis | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0280-7

  Allergic rhinitis is a common disorder that is strongly linked to asthma and conjunctivitis. It is usually a long-standing condition that often goes undetected in the primary-care setting. A thorough history, physical examination and allergen skin testing are important for establishing the diagnosis of allergic rhinitis. […] Comprehensive and widely-accepted Canadian guidelines for the diagnosis and treatment of allergic rhinitis were published in 2007. This article provides an overview and update of the recommendations provided in these guidelines as well as a review of current literature related to the pathophysiology, diagnosis, and appropriate management of allergic rhinitis. […] Allergic rhinitis is usually a long-standing condition that often goes undetected in the primary-care setting. Patients suffering from the disorder often fail to recognize the impact of the disorder on quality of life and functioning and, therefore, do not frequently seek medical attention. In addition, physicians fail to regularly question patients about the disorder during routine visits. Therefore, screening for rhinitis is recommended, particularly in asthmatic patients since studies have shown that rhinitis is present in up to 95% of patients with asthma.

• #1 Allergic Rhinitis | AAFP

  https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/allergic-rhinitis.html

  The diagnosis of allergic rhinitis (AR) should be made when history and physical findings are consistent with an allergic cause (e.g., clear rhinorrhea, pale discoloration of nasal mucosa, and red and watery eyes) and one or more of the following symptoms: nasal congestion, runny nose, itchy nose, or sneezing. […] Specific IgE testing (blood or skin) should be performed for patients with a clinical diagnosis of AR who do not respond to empiric treatment, or when diagnosis is uncertain, or when determination of specific target allergen is needed. […] Sinonasal imaging should not routinely be performed in patients presenting with symptoms consistent with allergic rhinitis. […] Immunotherapy should be prescribed for patients with AR who have inadequate response to pharmacologic therapy.

• #1 Allergic rhinitis | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0280-7

  A thorough history and physical examination are the cornerstones of establishing the diagnosis of allergic rhinitis. Allergy testing is also important for confirming that underlying allergies cause the rhinitis. Referral to an allergist should be considered if the diagnosis of allergic rhinitis is in question. […] Important elements of the history for patients with suspected allergic rhinitis are summarized in Table 2. […] Although a thorough history and physical examination are required to establish the clinical diagnosis of rhinitis, further diagnostic testing is necessary to confirm that underlying allergies cause the rhinitis. Skin-prick testing is considered the primary method for identifying specific allergic triggers of rhinitis. […] The treatment goal for allergic rhinitis is relief of symptoms. Therapeutic options available to achieve this goal include avoidance measures, nasal saline irrigation, oral antihistamines, intranasal corticosteroids, combination intranasal corticosteroid/antihistamine sprays; leukotriene receptor antagonists (LTRAs), and allergen immunotherapy. […] If the patients symptoms persist despite appropriate treatment, referral to an allergist should be considered. […] Allergen immunotherapy is an effective immune-modulating treatment that should be recommended if pharmacologic therapy for allergic rhinitis is not effective or is not tolerated.

• #1 Diagnosing Rhinitis: Allergic vs. Nonallergic | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0501/p1583.html

  Allergic rhinitis, the most common type of rhinitis, generally can be differentiated from the numerous types of nonallergic rhinitis through a thorough history and physical examination. […] Since 1998, three large expert panels have made recommendations for the diagnosis of allergic and nonallergic rhinitis. Allergy testing (e.g., percutaneous skin testing, radioallergosorbent testing) is not necessary in all patients but may be useful in ambiguous or complicated cases. […] Accurate diagnosis is important because therapies that are effective for allergic rhinitis (i.e., antihistamines and nasal corticosteroids) may be less effective for other types of rhinitis. […] An allergy test should be performed if the patient has severe symptoms or an unclear diagnosis or if he or she is a potential candidate for allergen avoidance treatment or immunotherapy.

• #1 Allergic rhinitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/232

  Key diagnostic factors include sneezing and nasal pruritus. […] Other diagnostic factors include 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, and Dennie-Morgan lines (creases present under the lower eyelids). […] 1st tests to order include therapeutic trial of antihistamine or intranasal corticosteroid. […] Tests to consider include allergen skin-prick testing and in vitro specific IgE determination.

• #1 Allergic and Mixed Rhinitis: Diagnosis and Natural Evolution

  https://www.mdpi.com/2077-0383/8/11/2019

  Distinguishing between the various rhinitis phenotypes can be confusing as the clinical presentation for each can be similar. […] Understanding the subtle differences between these conditions allows for a more accurate diagnostic approach, leading to better symptom control and improvement of quality of life. […] A comprehensive past medical history and focused physical exam serves as the cornerstone for a complete workup that can provide clues for what rhinitis phenotype the patient may have. […] Classic physical findings suggestive of seasonal AR include “allergic shiners” (i.e., discoloration under the lower eyelids related to vasodilation or venous congestion); “allergic salute” or horizontal nasal crease across the lower half of the bridge of the nose caused by repeated upward rubbing of the tip of the nose by the palm of the hand; mouth breathing; conjunctivitis; and edematous, pale, boggy nasal mucosa.

• #1 Allergic Rhinitis (AR) Diagnosis | Haleon HealthPartner

  https://www.haleonhealthpartner.com/en-us/respiratory-health/conditions/allergic-rhinitis-conditions-home/allergic-rhinitis/allergic-rhinitis-diagnosis/

  Allergic rhinitis (AR) can be either seasonal or perennial (i.e., year-round) in duration. SAR and PAR can be distinguished based on the allergens that trigger symptoms, by how long the symptoms last, and by what time of year the symptoms occur at. There is evidence that PAR patients will require allergy medications throughout the year, while SAR patients will require allergy medications predominantly around pollen allergy seasons: April, May, and June for the spring allergy season and August, September, and October for the fall allergy season. […] The accepted classification system for AR now goes beyond seasonal and perennial and includes a new subdivision of intermittent (IAR) or persistent (PER) disease. The severity of AR is classified as mild or moderate/severe depending on symptoms and quality of life.

• #1 Diagnosing Rhinitis: Allergic vs. Nonallergic | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0501/p1583.html

  A comprehensive history and physical examination should be used to help diagnose the cause of rhinitis. […] The most common diagnostic tests for allergic rhinitis are the percutaneous skin test and the allergen-specific immunoglobulin E (IgE) antibody test. […] Skin testing involves introducing controlled amounts of allergen and control substances into the skin. […] Allergic rhinitis can be categorized into three basic subgroups: seasonal, perennial, and occupational. […] The diagnosis of nonallergic rhinitis is made after eliminating allergic or IgE-mediated causes. […] The main controversy is how to differentiate allergic rhinitis from nonallergic rhinitis. […] Management of allergic and nonallergic rhinitis is slightly different; therefore, as more clinical data become available, determining the difference between the two types will become more important.

• #1 Allergic rhinitis: diagnosis and treatment – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/feature/allergic-rhinitis-diagnosis-and-treatment

  Allergic rhinitis (AR) is a common inflammatory nasal condition that affects 10–15% of children and 26% of adults in the UK. […] Symptoms can be intermittent (less than four days per week or for less than four consecutive weeks) or persistent (more than four days per week and for more than four consecutive weeks). […] Common symptoms of allergic rhinitis can range from mild to severe and may include nasal and ocular symptoms. Patients should be asked about the type, frequency, severity and persistence of symptoms and where they experience them. […] Patients should trial avoidance strategies and consider pharmacological options if symptoms persist or are moderate to severe. […] Pharmacological options vary depending on patient preference, age, and the severity and persistence of their symptoms.

• #1 Allergic Rhinitis (Hay Fever): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/8622-allergic-rhinitis-hay-fever

  Allergic rhinitis occurs when your body’s immune system reacts to an irritant in the air. The irritants (allergens) are so tiny that you can easily inhale them through your nose or mouth. […] Your healthcare provider will examine you, ask about your symptoms and evaluate you for other conditions, such as a cold or asthma. They can also perform allergy tests. […] A blood allergy test measures antibodies to an allergen in a sample of your blood. This blood test is called an immunoglobulin E (IgE) test. It can detect most types of allergies, including food allergies. […] Your provider may also recommend a skin prick and/or intradermal test to determine what allergens are causing your symptoms. In a skin prick test, your provider places a small sample of different allergens on your skin (usually on your forearm or back). They scratch or prick your skin with a needle. If you’re allergic to a specific allergen, the area will become red, itchy and irritated in 15 to 30 minutes. Intradermal testing is similar, but your allergist places the allergen underneath your skin. Your skin reacts in the same way it does for a prick test.

• #1 Allergic Rhinitis Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/134825-workup

  Testing for reaction to specific allergens can be helpful to confirm the diagnosis of allergic rhinitis and to determine specific allergic triggers. […] Allergy skin tests (immediate hypersensitivity testing) are an in vivo method of determining immediate (IgE-mediated) hypersensitivity to specific allergens. […] The antigen in the extract binds to IgE on skin mast cells, leading to the early-phase (immediate-type) reaction, which results in the release of mediators such as histamine. […] In vitro allergy tests, ie, FEIA, allow measurement of the amount of specific IgE to individual allergens in a sample of blood. […] This is a measurement of the total level of IgE in the blood (regardless of specificity). […] As with the total serum IgE, an elevated eosinophil count supports the diagnosis of allergic rhinitis, but it is neither sensitive nor specific for the diagnosis.

• #1 Allergic Rhinitis Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/134825-workup

  While radiographic studies are not needed to establish the diagnosis of allergic rhinitis, they can be helpful for evaluating possible structural abnormalities or to help detect complications or comorbid conditions, such as sinusitis or adenoid hypertrophy. […] A nasal smear can sometimes be helpful for establishing the diagnosis of allergic rhinitis. […] While not routinely indicated, upper airway endoscopy (rhinolaryngoscopy) can be performed if a complication or comorbid condition may be present. […] This procedure is essentially a research tool and is rarely indicated in the routine evaluation of allergic rhinitis.

• #1 Diagnosis and Treatment of Local Allergic Rhinitis

  https://www.mdpi.com/2076-0817/11/1/80

  Since the measurement of IgE antibodies in peripheral blood and antigen identification testing by skin prick tests are inadequate diagnostic tools for LAR, difficulties are associated with reaching an accurate diagnosis and, thus, the assessment of local responses in NAPT is required. […] NAPT is considered to be positive when symptom severity markedly increases or combined objective and symptom measurements are moderately elevated. […] The measurement of sIgE in nasal secretions is a non-invasive method for the diagnosis of LAR with high specificity, but low sensitivity (22–40% of responses). […] BAT has a sensitivity of 50% and specificity of >90% for Dermatophagoides pteronyssinus and a sensitivity of 66% and specificity of >90% for Olea europaea, which is useful for reaching a definitive diagnosis of LAR.

• #1 Allergic and Mixed Rhinitis: Diagnosis and Natural Evolution

  https://www.mdpi.com/2077-0383/8/11/2019

  Chronic rhinitis (CR) is divided into two main categories: allergic rhinitis (AR) and nonallergic rhinitis (NAR). […] However, an additional 30% to 50% of patients with CR might have an overlap of NAR and AR, referred to as mixed rhinitis (MR). […] Progress in elucidating the pathophysiologic mechanisms behind MR and NAR has been made in the past several years, and there are now several guidelines published to assist the clinician in accurately diagnosing AR, NAR, and MR. […] Clinical history and subjective symptoms can provide clues for differentiating AR from MR and NAR, but allergy testing is recommended to confirm these conditions. […] Establishing the correct diagnosis is the first step toward better medical management. […] Therefore, an accurate diagnosis of allergic and mixed rhinitis (MR) requires a better understanding of the various rhinitis phenotypes and endotypes.

• #1 Diagnostic Tools in Allergic Rhinitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8974728/

  Allergic mechanisms account for most cases of chronic rhinitis. The identification of the allergic triggers of rhinitis has been historically based on the performance of atopy test [skin prick test (SPT) and serum allergen-specific (s)IgE]. Nevertheless, these tests only denote sensitization, and atopy and allergy represent two different phenomena. It is now clear that allergic phenotypes of rhinitis can exist in both atopic (allergic rhinitis, AR) and non-atopic (local allergic rhinitis, LAR) individuals. Moreover, both allergic phenotypes can coexist in the same rhinitis patient (dual allergic rhinitis, DAR). Therefore, a diagnostic approach merely based on atopy tests is associated with a significant rate of misdiagnosis. The confirmation of the allergic etiology of rhinitis requires the performance of in vivo test like the nasal allergen challenge (NAC). NAC is mandatory for the diagnosis of LAR and DAR, and helps decide the best management approach in difficult cases of AR.

• #1 Allergic rhinitis: the “Ghost Diagnosis” in patients with asthma | Asthma Research and Practice | Full Text

  https://asthmarp.biomedcentral.com/articles/10.1186/s40733-015-0008-0

  Allergic rhinitis (AR) is a common comorbidity of asthma that contributes to asthma severity. […] Although over 80 % of asthmatics have AR, the condition is frequently underdiagnosed in subjects with asthma. […] Appropriate recognition, diagnosis and treatment of AR can significantly reduce asthma morbidity and improve quality of life. […] Both the Global Strategy for Asthma Management and Prevention and National Asthma Education and Prevention Programs Expert Panel Report (EPR-3) guidelines for the diagnosis and management of asthma recommend an evaluation for comorbid AR in patients with asthma. […] The initial evaluation of AR includes history and physical examination. […] Further testing for allergen-specific IgE antibodies should be done to assess for sensitization to suspected allergens.

• #1 Allergic rhinitis: the “Ghost Diagnosis” in patients with asthma | Asthma Research and Practice | Full Text

  https://asthmarp.biomedcentral.com/articles/10.1186/s40733-015-0008-0

  The majority of studies reaffirm current guidelines set by the Joint Task Force recommending that pulmonary functions tests be considered in patients with AR given the high risk of comorbid asthma. […] The diagnosis of AR can precede asthma. […] Studies of both adult and pediatric populations provide evidence for increased risk of asthma development in individuals with AR. […] The severity of airway obstruction at age 2 years and specific IgE levels to inhalant allergens could predict asthma at age 10 years and explain up to 30 % of the asthma variance observed. […] Current guidelines such as those from GINA and EPR-3 recommend an evaluation for AR in all patients with asthma. […] A large body of evidence supports such guidelines, as the recognition, diagnosis, and treatment of AR in subjects with asthma can reduce asthma morbidity and improve quality of life.

• #1 Diagnosis and management of allergic rhinitis | JAA

  https://www.dovepress.com/diagnosis-and-management-of-allergic-rhinitis-in-asthmatic-children-peer-reviewed-fulltext-article-JAA

  Allergic rhinitis (AR) is a common upper airways inflammatory condition especially in paediatric population; its burden potentially impacts on quality of life, quality of sleep and daily performance, which can be difficult to perceive but not less relevant in the middle-long term. […] The present review aims to provide an updated overview on AR epidemiology, diagnosis and with a special focus on its connections with bronchial asthma. […] In fact, when considering asthmatic pediatric population, AR is probably the most important risk factor for asthma onset and the most impactful extra-bronchial determinant of asthma control. […] Verifying the patients eligibility to that option should be considered as a priority for every physician managing children suffering from AR, especially when associated with bronchial asthma.

• #1 Nasal Allergy, Rhinitis and Allergic Rhinitis

  https://allergyasthmanetwork.org/allergies/nasal-allergy-allergic-rhinitis/

  Pregnancy rhinitis is common. It happens when a pregnant woman has congestion or a runny nose without having an illness or allergies. […] Pregnancy rhinitis can start at any point during pregnancy but it seems to happen most often during the second trimester. […] Nasal decongestants should not be used in the first trimester of pregnancy. Nasal decongestants would only be used sparingly and under a doctors advice in the later months of pregnancy. […] Pregnancy rhinitis symptoms can mirror those of respiratory infections, allergies and asthma flares.

• #1 Allergic Rhinitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538186/

  Allergic rhinitis is largely a clinical diagnosis made based on a thorough history and physical. […] Taking a thorough, detailed history is an essential part of the evaluation of AR. […] Patients often underestimate the severity of this condition and fail to seek medical therapy. It is important to adequately control AR, especially due to the link between AR and asthma, with poor control of rhinitis predicting poor control of asthma. […] Patients who fail traditional therapies for AR are eligible for referral to a specialist, such as an allergist or an otolaryngologist (ENT) with an allergy focus.

• #1 Hay Fever / Rhinitis

  https://www.aaaai.org/conditions-treatments/allergies/hay-fever-rhinitis

  Allergic rhinitis can also be triggered by common indoor allergens such as the dried skin flakes, urine and saliva found on pet dander, mold, droppings from dust mites and cockroach particles. This is called perennial allergic rhinitis, as symptoms typically occur year-round. […] An allergist / immunologist has specialized training and experience to diagnose specific allergens that trigger your illness, or to determine if your symptoms are non-allergic. Your allergist will take a thorough health history followed by allergy testing. Skin tests or blood tests are the most common methods for determining your allergic rhinitis triggers. […] Once specific allergens are diagnosed, your allergist / immunologist will work with you to develop a plan to avoid allergens that trigger your symptoms.

• #1 Diagnosis and management of allergic rhinitis | JAA

  https://www.dovepress.com/diagnosis-and-management-of-allergic-rhinitis-in-asthmatic-children-peer-reviewed-fulltext-article-JAA

  Allergic rhinitis often represents a comorbidity in asthma children treated with inhaled corticosteroids and it is important to take into consideration the development of systemic side effects. […] The presence of AR is a significant early-life predictor for an accelerated decline in lung function from the first to the sixth decade of life. […] Taken together, these findings suggest that AR should be routinely investigated in children and adolescents with asthma in order to optimize treatment and achieve better asthma control and, likewise, the resolution of AR symptoms. […] AIT does represent a unique opportunity to specifically interfere with AR immunological background, improve both AR and bronchial asthma control and prevent allergic disease evolution. […] The efficacy and safety of AIT in patients with AR have been demonstrated by many trials, demonstrating symptoms and QOL improvement, reduction in medication use and health-care costs as well as documenting a preventive effect on disease evolution from AR to asthma. […] In fact, AIT does represent a unique opportunity to specifically interfere with AR immunological background, to improve both AR and bronchial asthma control and to prevent allergic disease evolution.

• #2 Diagnostic Tools in Allergic Rhinitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8974728/

  Allergic mechanisms account for most cases of chronic rhinitis. The identification of the allergic triggers of rhinitis has been historically based on the performance of atopy test [skin prick test (SPT) and serum allergen-specific (s)IgE]. Nevertheless, these tests only denote sensitization, and atopy and allergy represent two different phenomena. It is now clear that allergic phenotypes of rhinitis can exist in both atopic (allergic rhinitis, AR) and non-atopic (local allergic rhinitis, LAR) individuals. Moreover, both allergic phenotypes can coexist in the same rhinitis patient (dual allergic rhinitis, DAR). Therefore, a diagnostic approach merely based on atopy tests is associated with a significant rate of misdiagnosis. The confirmation of the allergic etiology of rhinitis requires the performance of in vivo test like the nasal allergen challenge (NAC). NAC is mandatory for the diagnosis of LAR and DAR, and helps decide the best management approach in difficult cases of AR.

• #2 Allergic rhinitis | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0280-7

  A thorough history and physical examination are the cornerstones of establishing the diagnosis of allergic rhinitis. Allergy testing is also important for confirming that underlying allergies cause the rhinitis. Referral to an allergist should be considered if the diagnosis of allergic rhinitis is in question. […] Important elements of the history for patients with suspected allergic rhinitis are summarized in Table 2. […] Although a thorough history and physical examination are required to establish the clinical diagnosis of rhinitis, further diagnostic testing is necessary to confirm that underlying allergies cause the rhinitis. Skin-prick testing is considered the primary method for identifying specific allergic triggers of rhinitis. […] The treatment goal for allergic rhinitis is relief of symptoms. Therapeutic options available to achieve this goal include avoidance measures, nasal saline irrigation, oral antihistamines, intranasal corticosteroids, combination intranasal corticosteroid/antihistamine sprays; leukotriene receptor antagonists (LTRAs), and allergen immunotherapy. […] If the patients symptoms persist despite appropriate treatment, referral to an allergist should be considered. […] Allergen immunotherapy is an effective immune-modulating treatment that should be recommended if pharmacologic therapy for allergic rhinitis is not effective or is not tolerated.

• #2 Diagnosing Rhinitis: Allergic vs. Nonallergic | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0501/p1583.html

  A comprehensive history and physical examination should be used to help diagnose the cause of rhinitis. […] The most common diagnostic tests for allergic rhinitis are the percutaneous skin test and the allergen-specific immunoglobulin E (IgE) antibody test. […] Skin testing involves introducing controlled amounts of allergen and control substances into the skin. […] Allergic rhinitis can be categorized into three basic subgroups: seasonal, perennial, and occupational. […] The diagnosis of nonallergic rhinitis is made after eliminating allergic or IgE-mediated causes. […] The main controversy is how to differentiate allergic rhinitis from nonallergic rhinitis. […] Management of allergic and nonallergic rhinitis is slightly different; therefore, as more clinical data become available, determining the difference between the two types will become more important.

• #2 Allergic rhinitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/232

  Key diagnostic factors include sneezing and nasal pruritus. […] Other diagnostic factors include 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, and Dennie-Morgan lines (creases present under the lower eyelids). […] 1st tests to order include therapeutic trial of antihistamine or intranasal corticosteroid. […] Tests to consider include allergen skin-prick testing and in vitro specific IgE determination.

• #2 Allergic and Mixed Rhinitis: Diagnosis and Natural Evolution

  https://www.mdpi.com/2077-0383/8/11/2019

  Distinguishing between the various rhinitis phenotypes can be confusing as the clinical presentation for each can be similar. […] Understanding the subtle differences between these conditions allows for a more accurate diagnostic approach, leading to better symptom control and improvement of quality of life. […] A comprehensive past medical history and focused physical exam serves as the cornerstone for a complete workup that can provide clues for what rhinitis phenotype the patient may have. […] Classic physical findings suggestive of seasonal AR include “allergic shiners” (i.e., discoloration under the lower eyelids related to vasodilation or venous congestion); “allergic salute” or horizontal nasal crease across the lower half of the bridge of the nose caused by repeated upward rubbing of the tip of the nose by the palm of the hand; mouth breathing; conjunctivitis; and edematous, pale, boggy nasal mucosa.

• #2 Differential Diagnoses

  https://u.osu.edu/allergicrhinitis2019/differential-diagnosis/

  Patients with allergic rhinitis may experience clinical manifestations that affect the nasal mucosa, eyes, respiratory tract, and skin. […] The nasal mucosa often appear inflamed and swollen, but pale in color (Honan, 2019). […] Congestion in the nose occurs due to the swollen nasal conchae and excess production of mucus (Honan, 2019). […] Clinical manifestations of allergic rhinitis typically remain until the allergen is removed. […] To prevent the development of these serious complications later in life, a diagnosis and treatment regimen should be implemented early, when clinical manifestations first appear (Honan, 2019). […] There are a variety of diagnostic tests that would be valuable to confirm that B.B.s symptoms are a result of allergic rhinitis. […] If the laboratory serum assay for IgE antibodies indicates that an allergic reaction is occurring, then follow-up skin or serum tests to determine the specific allergens will further clarify the allergic triggers (Honan, 2019). […] Furthermore, allergic rhinitis has been associated with multiple gene mutations of cytokines that regulate IgE synthesis (McCance Heuther, 2019), so genetic testing may also be valuable to determine a diagnosis of allergic rhinitis.

• #2 Allergic Rhinitis (AR) Diagnosis | Haleon HealthPartner

  https://www.haleonhealthpartner.com/en-us/respiratory-health/conditions/allergic-rhinitis-conditions-home/allergic-rhinitis/allergic-rhinitis-diagnosis/

  Allergic rhinitis (AR) can be either seasonal or perennial (i.e., year-round) in duration. SAR and PAR can be distinguished based on the allergens that trigger symptoms, by how long the symptoms last, and by what time of year the symptoms occur at. There is evidence that PAR patients will require allergy medications throughout the year, while SAR patients will require allergy medications predominantly around pollen allergy seasons: April, May, and June for the spring allergy season and August, September, and October for the fall allergy season. […] The accepted classification system for AR now goes beyond seasonal and perennial and includes a new subdivision of intermittent (IAR) or persistent (PER) disease. The severity of AR is classified as mild or moderate/severe depending on symptoms and quality of life.

• #2 Allergic rhinitis | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-020-00227-0

  Allergic rhinitis (AR) is caused by immunoglobulin E (IgE)-mediated reactions to inhaled allergens and is one of the most common chronic conditions globally. […] The diagnosis is based on the clinical history and, if needed in patients with uncontrolled rhinitis despite medications or with long-lasting symptoms, on skin tests or the presence of serum-specific IgE antibodies to allergens. […] The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative classified AR into intermittent or persistent and mild or moderate/severe. […] The most frequently used pharmacological treatments include oral, intranasal or ocular H1-antihistamines, intranasal corticosteroids or a fixed combination of intranasal H1-antihistamines and corticosteroids. […] Allergen immunotherapy prescribed by a specialist using high-quality extracts in stratified patients is effective in patients with persistent symptoms.

• #2 Allergic rhinitis: diagnosis and treatment – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/feature/allergic-rhinitis-diagnosis-and-treatment

  Allergic rhinitis (AR) is a common inflammatory nasal condition that affects 10–15% of children and 26% of adults in the UK. […] Symptoms can be intermittent (less than four days per week or for less than four consecutive weeks) or persistent (more than four days per week and for more than four consecutive weeks). […] Common symptoms of allergic rhinitis can range from mild to severe and may include nasal and ocular symptoms. Patients should be asked about the type, frequency, severity and persistence of symptoms and where they experience them. […] Patients should trial avoidance strategies and consider pharmacological options if symptoms persist or are moderate to severe. […] Pharmacological options vary depending on patient preference, age, and the severity and persistence of their symptoms.

• #2 Diagnosing Rhinitis: Allergic vs. Nonallergic | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0501/p1583.html

  Allergic rhinitis, the most common type of rhinitis, generally can be differentiated from the numerous types of nonallergic rhinitis through a thorough history and physical examination. […] Since 1998, three large expert panels have made recommendations for the diagnosis of allergic and nonallergic rhinitis. Allergy testing (e.g., percutaneous skin testing, radioallergosorbent testing) is not necessary in all patients but may be useful in ambiguous or complicated cases. […] Accurate diagnosis is important because therapies that are effective for allergic rhinitis (i.e., antihistamines and nasal corticosteroids) may be less effective for other types of rhinitis. […] An allergy test should be performed if the patient has severe symptoms or an unclear diagnosis or if he or she is a potential candidate for allergen avoidance treatment or immunotherapy.

• #2 Allergic Rhinitis Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/134825-workup

  Testing for reaction to specific allergens can be helpful to confirm the diagnosis of allergic rhinitis and to determine specific allergic triggers. […] Allergy skin tests (immediate hypersensitivity testing) are an in vivo method of determining immediate (IgE-mediated) hypersensitivity to specific allergens. […] The antigen in the extract binds to IgE on skin mast cells, leading to the early-phase (immediate-type) reaction, which results in the release of mediators such as histamine. […] In vitro allergy tests, ie, FEIA, allow measurement of the amount of specific IgE to individual allergens in a sample of blood. […] This is a measurement of the total level of IgE in the blood (regardless of specificity). […] As with the total serum IgE, an elevated eosinophil count supports the diagnosis of allergic rhinitis, but it is neither sensitive nor specific for the diagnosis.

• #2 Hay fever – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hay-fever/diagnosis-treatment/drc-20373045

  Skin surface showing a positive reaction to allergy test Positive reaction to allergy test […] To diagnose hay fever, a healthcare professional typically does a physical exam and talks about general health, symptoms and possible triggers. One or both of these tests may be recommended: […] Skin prick test. Small amounts of material that can trigger allergies are pricked into patches of skin on the arm or upper back. A medical professional then watches the skin for an allergic reaction. If someone has an allergy, a raised bump called a hive forms at the site of that allergen. This typically takes about 15 to 20 minutes. Allergy specialists usually are best equipped to perform allergy skin tests. […] Allergy blood test. A blood sample is sent to a lab to measure the immune system’s response to a specific allergen. This test measures the amount of allergy-causing antibodies in the bloodstream, known as immunoglobulin E (IgE) antibodies.

• #2 Allergic & Nonallergic Rhinitis NYC | Mount Sinai – New York

  https://www.mountsinai.org/care/ent/services/nasal-sinus-allergy/conditions/rhinitis

  Blood testing: can measure antibodies to allergens in your bloodstream called immunoglobulin E (IgE) antibodies. The lab will then reveal if there is evidence of specific allergen sensitivities. […] For nonallergic rhinitis, allergy testing as noted above is often performed to rule out any sensitivities. It is important to provide your physician with symptoms, triggers, timing, a full list of current medications (both OTC and prescription)- so that a proper diagnosis can be made. Interestingly, there is no definitive test or exam for diagnosing nonallergic rhinitis. Your physician may order blood work or a CT scan to rule out any other diseases (sinusitis or cerebrospinal brain fluid leak). Your provider may also use a small camera to look into the nasal cavity, back of the nose to determine any other warning signs. The test is painless and can provide a volume of information.

• #2 Allergic rhinitis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000813.htm

  Allergic rhinitis is a diagnosis associated with a group of symptoms affecting the nose. These symptoms occur when you breathe in something you are allergic to, such as dust, animal dander, or pollen. […] Allergy testing may reveal the pollen or other substances that trigger your symptoms. Skin testing is the most common method of allergy testing. […] If your provider determines you cannot have skin testing, special blood tests may help with the diagnosis. These tests, known as IgE RAST tests, can measure the levels of allergy-related substances. […] A blood test, called the eosinophil count, may also help diagnose allergies.

• #2 Allergic and Mixed Rhinitis: Diagnosis and Natural Evolution

  https://www.mdpi.com/2077-0383/8/11/2019

  A wide number of methods for classifying and diagnosing rhinitis subtypes have been proposed, including nasal cytology, peak nasal inspiratory flow rates, anterior rhinomanometry, acoustic rhinometry, irritant index scales, specific biomarkers, nasal provocation testing with environmental exposure chambers, and nasolaryngoscopy. […] All of these proposed testing methods are an attempt by investigators to more accurately subtype CR in order to develop more focused treatment plans for the patient and improve their clinical outcomes. […] Progress in accurately diagnosing patients with CR will be made as studies incorporate subjective (i.e., validated questionnaires such as the irritant index questionnaire (IIQ), medication responsiveness, and quality-of-life tools) and objective (i.e., nasal cytologic testing, nasal provocation, and biomarkers) methods characterizing rhinitis subtypes.

• #2 Allergic Rhinitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/134825-overview

  Total blood eosinophil count: Neither sensitive nor specific for the diagnosis, but, as with total serum IgE, can sometimes be helpful when combined with other factors. […] Imaging studies used in the diagnosis and evaluation of allergic rhinitis include the following: Radiography: Can be helpful for evaluating possible structural abnormalities or to help detect complications or comorbid conditions, such as sinusitis or adenoid hypertrophy. […] Computed tomography scanning: Can be very helpful for evaluating acute or chronic sinusitis. […] Magnetic resonance imaging: Also can be helpful for evaluating sinusitis.

• #2 Allergic and Mixed Rhinitis: Diagnosis and Natural Evolution

  https://www.mdpi.com/2077-0383/8/11/2019

  Chronic rhinitis (CR) is divided into two main categories: allergic rhinitis (AR) and nonallergic rhinitis (NAR). […] However, an additional 30% to 50% of patients with CR might have an overlap of NAR and AR, referred to as mixed rhinitis (MR). […] Progress in elucidating the pathophysiologic mechanisms behind MR and NAR has been made in the past several years, and there are now several guidelines published to assist the clinician in accurately diagnosing AR, NAR, and MR. […] Clinical history and subjective symptoms can provide clues for differentiating AR from MR and NAR, but allergy testing is recommended to confirm these conditions. […] Establishing the correct diagnosis is the first step toward better medical management. […] Therefore, an accurate diagnosis of allergic and mixed rhinitis (MR) requires a better understanding of the various rhinitis phenotypes and endotypes.

• #2 Diagnosis and Treatment of Local Allergic Rhinitis

  https://www.mdpi.com/2076-0817/11/1/80

  Some patients with chronic rhinitis have a positive nasal allergen provocation test (NAPT) without systemic IgE sensitization by skin prick tests or serum allergen-specific IgE (sIgE). This novel concept is called local allergic rhinitis (LAR) and affects children and adults worldwide, but is underdiagnosed. […] A differential diagnosis of LAR needs to be considered in patients with symptoms suggestive of AR in the absence of systemic atopy, regardless of age. The diagnostic method for LAR relies on positive responses to single or multiple allergens in NAPT, the sensitivity, specificity, and reproducibility of which are high. […] LAR is diagnosed based on a detailed history, medical interview, a nasal allergic reaction by NAPT, and the exclusion of chronic sinusitis with or without nasal polyps in patients with a negative skin prick test and undetectable sIgE. NAPT and the identification of antigen-specific IgE antibodies in nasal secretions are central to confirming a diagnosis of LAR.

• #2

  https://www2.hse.ie/conditions/allergic-rhinitis/allergic-rhinitis-diagnosis/

  Your GP can often diagnose allergic rhinitis from your symptoms and medical history. […] Your GP can confirm a diagnosis of allergic rhinitis when treatment starts. If your symptoms improve after taking antihistamines, it’s likely that it’s caused by an allergy. […] If the exact cause of allergic rhinitis is uncertain, your GP may refer you for allergy testing. […] Test results need to be reviewed by a professional with detailed knowledge of your symptoms and medical history. […] There are 2 main allergy tests: […] Blood tests check for the immunoglobulin E (IgE) antibody in your blood. Your immune system produces this antibody in response to an allergen. […] You may need other hospital tests to check for complications, such as nasal polyps or sinusitis.

• #2 Allergic rhinitis: the “Ghost Diagnosis” in patients with asthma | Asthma Research and Practice | Full Text

  https://asthmarp.biomedcentral.com/articles/10.1186/s40733-015-0008-0

  A study of allergic rhinitis symptoms in a diverse US urban population of 166 children with known asthma identified rhinitis symptoms in 72 % of subjects, with AR undiagnosed in 53 %. […] A cross-sectional population-based study in six Colombian cities noted that the prevalence of subjects reporting current AR symptoms was 32 %, while the prevalence of physician diagnosed AR was lower at 14 %. […] Underdiagnosis of AR also occurs in adult populations. […] Evaluation of AR by an allergist/immunologist improves patient health-related quality of life outcomes including general health, social functioning and vitality. […] The ARIA working group has proposed that AR and asthma may be manifestations of one syndrome in two parts of the respiratory tract, with more severe AR corresponding directly with more severe asthma.

• #2 Diagnosis and management of allergic rhinitis | JAA

  https://www.dovepress.com/diagnosis-and-management-of-allergic-rhinitis-in-asthmatic-children-peer-reviewed-fulltext-article-JAA

  Allergic rhinitis can be classified as intermittent or persistent, following symptoms duration, and mildmoderate or severe when taking into account symptoms severity. […] The clinical history is essential for diagnosing and profiling rhinitis in children in order to provide the most appropriate treatment and to establish the best management for the patient. […] Defining the allergic sensitization profile through skin prick testing (SPT) or specific serum IgE, is essential in light of a complete diagnostic work-up and for further treatment selection, especially if allergen immunotherapy (AIT) might be considered. […] The measurement of serum-specific IgE represents an in vitro test to explore the sensitization profile. […] The clinical suspect of AR firstly relies on symptoms, including one or more of the following symptoms, such as pruritus, sneezing, rhinorrhoea, nasal congestion, and hyposmia that arise within minutes after the exposition to allergen until 12 hours; late symptoms are nasal obstruction, hyposmia, nasal hyper reactivity and post nasal mucous discharge.

• #2 Diagnosis and management of allergic rhinitis | JAA

  https://www.dovepress.com/diagnosis-and-management-of-allergic-rhinitis-in-asthmatic-children-peer-reviewed-fulltext-article-JAA

  Allergic rhinitis often represents a comorbidity in asthma children treated with inhaled corticosteroids and it is important to take into consideration the development of systemic side effects. […] The presence of AR is a significant early-life predictor for an accelerated decline in lung function from the first to the sixth decade of life. […] Taken together, these findings suggest that AR should be routinely investigated in children and adolescents with asthma in order to optimize treatment and achieve better asthma control and, likewise, the resolution of AR symptoms. […] AIT does represent a unique opportunity to specifically interfere with AR immunological background, improve both AR and bronchial asthma control and prevent allergic disease evolution. […] The efficacy and safety of AIT in patients with AR have been demonstrated by many trials, demonstrating symptoms and QOL improvement, reduction in medication use and health-care costs as well as documenting a preventive effect on disease evolution from AR to asthma. […] In fact, AIT does represent a unique opportunity to specifically interfere with AR immunological background, to improve both AR and bronchial asthma control and to prevent allergic disease evolution.

• #2 Allergic Rhinitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538186/

  Allergic rhinitis (AR) is an atopic disease presenting with symptoms of sneezing, nasal congestion, clear rhinorrhea, and nasal pruritis. […] This activity describes the evaluation and treatment of allergic rhinitis and highlights the role of the interprofessional team in improving care for patients with this condition. […] Once diagnosed, AR is treatable with a variety of modalities, with intra-nasal glucocorticoids being the first-line therapy. […] A positive response to empiric treatment with a nasal glucocorticoid can support the diagnosis. A formal diagnosis is possible with either serum testing for allergen-specific IgE or allergy skin testing. […] Allergy testing should be reserved for patients who are unresponsive to empiric treatment or require the identification of a specific allergen to target therapy.

• #2 Hay Fever / Rhinitis

  https://www.aaaai.org/conditions-treatments/allergies/hay-fever-rhinitis

  Immunotherapy (allergy shots) is a proven treatment approach providing long-term relief for many people suffering from allergic rhinitis. […] Your allergist might prescribe medication to decrease allergic rhinitis symptoms. These medications may include nasal corticosteroid sprays, antihistamine pills, nasal antihistamine sprays or decongestant pills. […] The majority of allergy medications for seasonal allergic rhinitis (hay fever) work best if started before tree pollen is in the air each spring and allergy symptoms develop.

• #3 Allergic Rhinitis: Types, Signs, Causes & Treatments | Ada

  https://ada.com/conditions/allergic-rhinitis/

  Guidelines for diagnosis of allergic rhinitis are usually based on the symptoms reported by the affected person and their family history. Additional tests are sometimes required if the trigger for the allergic rhinitis is unknown. These tests involve giving the affected person small amounts of specific allergens to see if an allergic reaction takes place. This may include one or more of the following tests: […] An intradermal test is normally the most accurate way to determine whether an individual is suffering from allergic rhinitis. Possible allergens, such as grass and weed pollen, are injected under the skin. After 20 minutes, the site is monitored for an allergic reaction, which usually involves reddening of the skin and an itching sensation. […] The prick or scratch test is the most common type of skin test. It involves pricking or scratching the skin before exposure to an allergen-containing solution. The results are known within 10 to 20 minutes.

• #3 Allergic Rhinitis – Immunology; Allergic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/immunology-allergic-disorders/allergic-autoimmune-and-other-hypersensitivity-disorders/allergic-rhinitis

  Occasionally, skin test results are equivocal, or testing cannot be done (eg, because patients are taking medications that interfere with results and cannot safely be withheld); then, an allergen-specific serum IgE test is done. […] A nasal smear to detect eosinophils can be done to confirm allergic rhinitis. Although the test is rarely done, it can be a useful alternative to needlesticks in children or used as an additional tool in the evaluation of rhinitis. […] Nonallergic perennial rhinitis is usually also diagnosed based on history. Lack of a clinical response to treatment for assumed allergic rhinitis and negative results on skin tests and/or an allergen-specific serum IgE test also suggest a nonallergic cause.

• #3 Diagnosis and Treatment of Local Allergic Rhinitis

  https://www.mdpi.com/2076-0817/11/1/80

  Some patients with chronic rhinitis have a positive nasal allergen provocation test (NAPT) without systemic IgE sensitization by skin prick tests or serum allergen-specific IgE (sIgE). This novel concept is called local allergic rhinitis (LAR) and affects children and adults worldwide, but is underdiagnosed. […] A differential diagnosis of LAR needs to be considered in patients with symptoms suggestive of AR in the absence of systemic atopy, regardless of age. The diagnostic method for LAR relies on positive responses to single or multiple allergens in NAPT, the sensitivity, specificity, and reproducibility of which are high. […] LAR is diagnosed based on a detailed history, medical interview, a nasal allergic reaction by NAPT, and the exclusion of chronic sinusitis with or without nasal polyps in patients with a negative skin prick test and undetectable sIgE. NAPT and the identification of antigen-specific IgE antibodies in nasal secretions are central to confirming a diagnosis of LAR.

• #3 Diagnosis and management of allergic rhinitis | JAA

  https://www.dovepress.com/diagnosis-and-management-of-allergic-rhinitis-in-asthmatic-children-peer-reviewed-fulltext-article-JAA

  Allergic rhinitis (AR) is a common upper airways inflammatory condition especially in paediatric population; its burden potentially impacts on quality of life, quality of sleep and daily performance, which can be difficult to perceive but not less relevant in the middle-long term. […] The present review aims to provide an updated overview on AR epidemiology, diagnosis and with a special focus on its connections with bronchial asthma. […] In fact, when considering asthmatic pediatric population, AR is probably the most important risk factor for asthma onset and the most impactful extra-bronchial determinant of asthma control. […] Verifying the patients eligibility to that option should be considered as a priority for every physician managing children suffering from AR, especially when associated with bronchial asthma.

• #3 Approach to allergic rhinitis in the primary care setting

  https://www1.racgp.org.au/ajgp/2024/supplement-november/approach-to-allergic-rhinitis-in-the-primary-care

  Imaging should only be considered to rule out other causes of nasal obstruction/rhinorrhoea if the history and examination is unconvincing. […] The four main aspects to the management of AR are allergen avoidance, pharmacotherapy, immunotherapy and, occasionally, surgery. […] Combination corticosteroid/antihistamine sprays are highly effective and convenient and are increasingly considered a first-line therapy. […] Referral to an allergist should be considered if specific allergen tests show significant airborne allergen sensitivity. […] An assessment in the primary care setting, with a targeted history, examination and panel of investigations, should be able to identify those with a significant burden of allergic disease.

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