Rhinitis history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2]
Overview
Rhinitis has significant impacts on the quality of life and productivity of the affected individual. Allergic rhinitis, which is the most common type of chronic rhinitis, is frequently underdiagnosed, mistreated, or sometimes ignored.[1] Effective management of rhinitis improves the quality of life, and control of coexisting conditions such as asthma and conjunctivitis.[2][3] Accurately diagnosing rhinitis by taking a careful history and physical examination, is important in order to ensure a timely intervention.[4]
History and Symptoms
History and Symptoms of Allergic Rhinitis[5][3][6][7]
The key history that should be obtained from a patient being evaluated for allergic rhinitis include:
- The classic symptoms of allergic rhinitis
- The pattern of the symptoms
- The precipitating factors
- Environmental history
- Coexisting conditions
- Family history
- Previous response to medications
Symptoms of Allergic Rhinitis: It is important to obtain a history of the symptoms of rhinitis, and also determine the symptoms that are most bothersome to the patient.
- Bilateral, watery rhinorrhea- Consider other diagnosis such as intranasal foreign bodies in children if unilateral, mucopurulent rhinorrhea is seen
- Nasal pruritus: This is also common in patients with NARES (Nonallergic Rhinitis with Eosinophilic Syndrome).
- Nasal congestion which often results in mouth breathing
- Sneezing (usually paroxysmal)
- Sniffing
- Frequent throat clearing
- Mild hyposmia may occur
- Cough (may be present if there is coexisting asthma, posterior rhinorrhea, etc)
Symptoms not suggestive of allergic rhinitis include the following:
- Unilateral nasal symptoms
- Nasal obstruction without other symptoms
- Mucopurulent rhinorrhea
- The presence of posterior rhinorrhoea(postnasal drip) only, with thick mucus
- Pain
- Recurrent epistaxis
- Anosmia
Pattern of symptoms of Allergic Rhinitis: It is important to ascertain the duration of the symptoms, the frequency, and the timing of the symptoms in relation to the allergen exposure, e.g
- Duration of symptoms in allergic rhinitis is usually >1hr on most days
- Intermittent symptoms
- Seasonal symptoms- Pollens are generally associated with seasonal allergic rhinitis (hay fever)
- Perrenial symptoms- There is very little variation between seasons for perennial allergens like house dust mites, domestic pets, and cockroaches. Pollens in some parts of California and some other regions have also been identified to cause perennial symptoms.
Precipitating factors
- Identification of the allergen
- Identification of the symptoms that are present following exposure to the allergen
Environmental history: This should include a history of possible allergen exposure at places such as:
- The home environment
- The work place
- The school
- Other places
Coexisting conditions: Other conditions can coexist with allergic Rhinitis, and they include:
- Allergic eye disease: Characterized by bilateral eye symptoms such as lacrimation, itching, redness. Allergic eye disease occurs in almost all patients with allergic rhinitis.[2]
- Asthma- Most patients with asthma have allergic rhinitis. Allergic rhinitis is a strong risk factor for the development of asthma, and it is also a major factor in the exacerbation of asthma.
- Oral allergy syndrome- Seen more often in individuals with pollen-induced allergic rhinitis, it occurs as a result of a cross-reaction of pollens with food derived from plants. Oral pruritus and/or local angioedema is seen in response to fruits and vegetables such as apples, hazelnuts, carrots, celery. Oral allergy syndrome has been estimated to affect about 25% of children with seasonal allergic rhinitis.
- Atopic dermatitis
- Adenoidal hypertrophy with/without obstructive sleep apnea
- Chronic rhinosinusitis- Usually from chronic allergic sinus inflammation
- Otitis media with effusion
Family history: A family history of allergic rhinitis or other atopic conditions, is an important diagnostic clue.
Previous response to medications: Response to medications such as antihistamines should be obtained during evaluation of the patient.
History and Symptoms of Nonallergic Rhinitis
Infectious rhinitis[6][7]: This is the most common form of nonallergic rhinitis in children. It is commonly associated with rhinosinusitis. Symptoms of infectious rhinitis/rhinosinusitis include:
- Bilateral mucopurulent rhinorrhea (the rhinorrhea can be anterior and/or posterior)
- Nasal congestion, sneezing, etc
- Facial pain, pressure and/or fullness- usually described as a dull pain or pressure in the upper cheeks, between the eyes, or in the forehead.
- Headache
- Nasal pruritis is usually absent
- Olfactory disturbances such as hyposmia or anosmia
- Fever
- Conjunctivitis and acute otitis media can occur
Nonallergic Rhinitis with Eosinophilia Syndrome(NARES)[8][6]: Symptoms are consistent with the symptoms seen in allergic rhinitis, however, the demonstration of the absence of allergic disease (via skin testing or serum IgE levels to environmental allergens), is the key distinguishing factor between NARES and allergic rhinitis. Anosmia can also be seen in NARES. NARES is perceived as a risk factor for nasal polyposis, aspirin sensitivity, and obstructive sleep apnea.
References
- ↑ Greiner AN, Hellings PW, Rotiroti G, Scadding GK (2011). "Allergic rhinitis". Lancet. 378 (9809): 2112–22. doi:10.1016/S0140-6736(11)60130-X. PMID 21783242.
- ↑ 2.0 2.1 Shaker M, Salcone E (2016). "An update on ocular allergy". Curr Opin Allergy Clin Immunol. 16 (5): 505–10. doi:10.1097/ACI.0000000000000299. PMID 27490123.
- ↑ 3.0 3.1 Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A; et al. (2008). "Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)". Allergy. 63 Suppl 86: 8–160. doi:10.1111/j.1398-9995.2007.01620.x. PMID 18331513.
- ↑ Skoner DP (2001). "Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis". J Allergy Clin Immunol. 108 (1 Suppl): S2–8. PMID 11449200.
- ↑ Rotiroti, Giuseppina; Scadding, Glenis (July 2016). "Allergic Rhinitis-an overview of a common disease". Paediatrics and Child Health. Volume 26 (Issue 7): 298–303. Retrieved January 20, 2017.
- ↑ 6.0 6.1 6.2 Dykewicz MS, Hamilos DL (2010). "Rhinitis and sinusitis". J Allergy Clin Immunol. 125 (2 Suppl 2): S103–15. doi:10.1016/j.jaci.2009.12.989. PMID 20176255.
- ↑ 7.0 7.1 Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA; et al. (2008). "The diagnosis and management of rhinitis: an updated practice parameter". J Allergy Clin Immunol. 122 (2 Suppl): S1–84. doi:10.1016/j.jaci.2008.06.003. PMID 18662584.
- ↑ Ellis AK, Keith PK (2006). "Nonallergic rhinitis with eosinophilia syndrome". Curr Allergy Asthma Rep. 6 (3): 215–20. PMID 16579871.