Clinical Diagnosis
Examination Imaging The diagnosis relies chiefly on clinical assessment and laboratory tests indicating allergic sensitisation. Clinical assessment should include a thorough history recording duration, seasonality and severity of symptoms, and examination. 7 Nasal and non-nasal symptoms can occur. 7,25,26 Symptoms of AR (which may be prolonged after allergen exposure) include the following: Nasal
The diagnosis relies chiefly on clinical assessment and laboratory tests indicating allergic sensitisation. Clinical assessment should include a thorough history recording duration, seasonality and severity of symptoms, and examination.7 Nasal and non-nasal symptoms can occur.7,25,26
Symptoms of AR (which may be prolonged after allergen exposure) include the following:
Nasal symptoms:
- Rhinorrhoea (anterior and posterior), sneezing, nasal blockage and itching and hyperreactivity of the mucosa to other allergens and non-allergic stimuli (e.g., irritants
- and strong odours)
Non-nasal associations:
- Allergic conjunctivitis, palatal itching, cough from postnasal drip, asthma exacerbations, sinusitis or otitis media.
- An impact on QoL, specifically cognitive dysfunction and sleep disturbance.
Examination
The examination should assess for signs of atopy such as the ‘allergic facies’ (pallor, allergic shiners, nasal creases, Dennie-Morgan lines and mouth breathing). The inferior turbinate should be examined for swelling and pallor. The patient should be evaluated for concomitant allergic diseases such as eczema and asthma. Comorbidities such as chronic rhinosinusitis (CRS), otitis media and hearing loss should be quantified. Other factors that can also cause nasal obstruction such as nasal polyposis, septal deviation, nasal deformities or mid-facial hypoplasia should be excluded.
Imaging
Plain film sinus X-rays have no place in the diagnosis. Computed tomography scanning should be reserved for suspected chronic sinus disease, particularly where surgery is contemplated.
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Richards GA, McDonald M, Gray CL, et al. Allergic rhinitis: Review of the diagnosis and management: South African Allergic Rhinitis Working Group. S Afr Fam Pract. 2023;65(1), a5806. https://doi.org/10.4102/safp.v65i1.5806