Neobook — clinical reference

Classification of severity

In SA, the Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines are widely applied⁹,¹⁷ despite the recognition of some weaknesses.^26,27These guidelines divide symptoms into intermittent or persistent and severity into mild or moderate-severe (Figure 1).^7,9

_{Click on the image to enlarge}
_{Source: From Greiner AN, Hellings PW, Rotiroti G, Scadding GK. Allergic rhinitis. Lancet.2011;378(9809):2112–2122. https://doi.org/10.1016/S0140-6736(11)60130-X and Brozek JL, Bousquet J, Baena-Cagnani CE, et al. Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126(3):466–476. https://doi.org/10.1016/j.jaci.2010.06.047}

FIGURE 1: Allergic Rhinitis and Its Impact on Asthma guidelines on allergic rhinitis categorisation in untreated patients.

Differential diagnosis

The differential diagnoses of AR must be considered to plan for appropriate testing (Table 1).^6,7,8,25,28

TABLE 1: Differential diagnosis of allergic rhinitis.

Inflammatory

Neurogenic/Vasomotor

Anatomical

- Occupational rhinitis
- Chemical rhinitis
- Autoimmune,
granulomatous and
vascular rhinitis
- Fungal rhinosinusitis
- Non-steroidal
exacerbated rhinitis/
Samter’s triad
- Acute or recurrent
infective rhinosinusitis
- Chronic rhinosinusitis
with or without nasal
polyposis
- Primary immune
deficiency
- Crèche syndrome
- Cystic fibrosis

- Vasomotor rhinitis
- Rhinitis medicamentosa
- Atrophic rhinitis
- Age-related rhinitis
- Smoke-induced rhinitis
- Non-allergic rhinitis
with eosinophilia
(NARES)

- Deviated septum/septal
spur
- Empty nose syndrome
- Antrochoanal polyp
- Foreign body
- Adenoidal hypertrophy
- Primary ciliary
dyskinesia

_{Source: Please see the full reference list of the article Sin B, Togias A. Pathophysiology of allergic and non-allergic rhinitis. Proc Am Thorac Soc 2011;8(1):106–114. https://doi.org/10.1513/pats.201008-057RN, for more information.}

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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