Rhinitis laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
The accurate diagnosis of rhinitis is highly dependent on a thorough history taking and physical examination. Laboratory investigations are never used solely for the diagnosis of rhinitis, but are often used in conjunction with the history and physical examination findings. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
The presenting symptoms of allergic and nonallergic rhinitis are sometimes difficult to distinguish, and it is often a diagnostic challenge to determine the etiology of rhinitis, whether it is allergic or nonallergic (or even an overlap of the two conditions).<ref name="pmid17153005">{{cite journal| author=Settipane RA, Charnock DR| title=Epidemiology of rhinitis: allergic and nonallergic. | journal=Clin Allergy Immunol | year= 2007 | volume= 19 | issue= | pages= 23-34 | pmid=17153005 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17153005 }} </ref> The accurate diagnosis allergic rhinitis relies on the clinical history, and the demonstration of the presence of allergic sensitization towards relevant allergens.<ref name="Allergic rhinitis-an overview of a common disease">{{cite journal |last=Rotiroti |first=Giuseppina |last2=Scadding |first2=Glenis |date=July 2016 |title=Allergic Rhinitis-an overview of a common disease |url=https://www-clinicalkey-com.ezp-prod1.hul.harvard.edu/#!/content/playContent/1-s2.0-S1751722216300063?returnurl=null&referrer=null&scrollTo=%23tbl2|journal=Paediatrics and Child Health |volume= Volume 26 |issue= Issue 7 |pages=298-303 |access-date=January 20, 2017 }} </ref><ref name="pmid18331513">{{cite journal| author=Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al.| title=Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). | journal=Allergy | year= 2008 | volume= 63 Suppl 86 | issue= | pages= 8-160 | pmid=18331513 | doi=10.1111/j.1398-9995.2007.01620.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18331513 }} </ref> Nonallergic rhinitis is a heterogeneous condition with a wide range of nasal pathological findings, which may require more targeted investigations.<ref name="pmid21783242">{{cite journal| author=Greiner AN, Hellings PW, Rotiroti G, Scadding GK| title=Allergic rhinitis. | journal=Lancet | year= 2011 | volume= 378 | issue= 9809 | pages= 2112-22 | pmid=21783242 | doi=10.1016/S0140-6736(11)60130-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21783242 }} </ref> Allergy investigations are never used alone for diagnosis because of the low specificity, and the test result should be interpreted in conjunction with the clinical history.<ref name="Allergic rhinitis-an overview of a common disease" /> | The presenting symptoms of allergic and nonallergic rhinitis are sometimes difficult to distinguish, and it is often a diagnostic challenge to determine the etiology of rhinitis, whether it is allergic or nonallergic (or even an overlap of the two conditions).<ref name="pmid17153005">{{cite journal| author=Settipane RA, Charnock DR| title=Epidemiology of rhinitis: allergic and nonallergic. | journal=Clin Allergy Immunol | year= 2007 | volume= 19 | issue= | pages= 23-34 | pmid=17153005 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17153005 }} </ref> The accurate diagnosis allergic rhinitis relies on the clinical history, and the demonstration of the presence of allergic sensitization towards relevant allergens.<ref name="Allergic rhinitis-an overview of a common disease">{{cite journal |last=Rotiroti |first=Giuseppina |last2=Scadding |first2=Glenis |date=July 2016 |title=Allergic Rhinitis-an overview of a common disease |url=https://www-clinicalkey-com.ezp-prod1.hul.harvard.edu/#!/content/playContent/1-s2.0-S1751722216300063?returnurl=null&referrer=null&scrollTo=%23tbl2|journal=Paediatrics and Child Health |volume= Volume 26 |issue= Issue 7 |pages=298-303 |access-date=January 20, 2017 }} </ref><ref name="pmid18331513">{{cite journal| author=Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al.| title=Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). | journal=Allergy | year= 2008 | volume= 63 Suppl 86 | issue= | pages= 8-160 | pmid=18331513 | doi=10.1111/j.1398-9995.2007.01620.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18331513 }} </ref> Nonallergic rhinitis is a heterogeneous condition with a wide range of nasal pathological findings, which may require more targeted investigations.<ref name="pmid21783242">{{cite journal| author=Greiner AN, Hellings PW, Rotiroti G, Scadding GK| title=Allergic rhinitis. | journal=Lancet | year= 2011 | volume= 378 | issue= 9809 | pages= 2112-22 | pmid=21783242 | doi=10.1016/S0140-6736(11)60130-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21783242 }} </ref> Allergy investigations are never used alone for diagnosis because of the low specificity, and the test result should be interpreted in conjunction with the clinical history.<ref name="Allergic rhinitis-an overview of a common disease" /> | ||
'''Laboratory Confirmation of Allergic Rhinitis''': Allergic rhinitis can be confirmed by recording specific IgE reactivity to relevant aeroallergens in the patient's history. This can be done via the following methods:<ref name="Allergic rhinitis-an overview of a common disease" /><ref name="pmid25644617">{{cite journal| author=Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR et al.| title=Clinical practice guideline: Allergic rhinitis. | journal=Otolaryngol Head Neck Surg | year= 2015 | volume= 152 | issue= 1 Suppl | pages= S1-43 | pmid=25644617 | doi=10.1177/0194599814561600 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25644617 }} </ref><ref name="pmid21783242" /><ref name="pmid20176255">{{cite journal| author=Dykewicz MS, Hamilos DL| title=Rhinitis and sinusitis. | journal=J Allergy Clin Immunol | year= 2010 | volume= 125 | issue= 2 Suppl 2 | pages= S103-15 | pmid=20176255 | doi=10.1016/j.jaci.2009.12.989 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20176255 }} </ref> | |||
* Skin | * Skin test (skin-prick or intradermal):The skin test yield result within minutes and are often preferred. Temporary stoppage of [[antihistamine]] use is required before skin testing. | ||
* RAST (radioallergosorbent test) | * [[RAST blood test|RAST]] (radioallergosorbent test): This is a blood test that detect specific [[IgE]] antibodies using radioimmunoassay test. It is less cost effective compared to the skin-prick test and takes several days to obtain the result. [[RAST test|RAST]] is a preferred test in patients with the following: | ||
* ''Nasal allergen challenge'' | # [[Dermographism]] | ||
# Severe [[atopic dermatitis]] | |||
# Lack of willingness to temporarily stop [[antihistamine]] use. | |||
* ''Nasal allergen challenge'': This is not routinely done. It is usually used in research and in the diagnosis of occupational rhinitis. | |||
* Total serum [[IgE]] and circulating eosinophil counts are not used for diagnosis of allergic rhinitis due to the lack of [[sensitivity]] and [[specificity]]. | |||
{{familytree/start}} | |||
{{familytree | | | | | | | | | A01 | | | | | |A01= Rhinitis}} | |||
{{familytree | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| }} | |||
{{familytree | | B01 | | | | | | | | | | | | B02|B01= Positive <br> Skin test or <br> [[RAST test]]|B02=Negative <br> Skin test or <br> [[RAST test]]}} | |||
{{familytree | | |!| | | | | | | | | | | | | |!|}} | |||
{{familytree | | C01 | | | | | | | | | | | | C02| |C01= Allergic Rhinitis|C02= Nonallergic Rhinitis}} | |||
{{familytree | | | | | | | | | | | | |,|-|-|-|+|-|-|-|v|-|-|-|.|}} | |||
{{familytree | | | | | | | | | | | | |!| | | |!| | | |!| | | |!|}} | |||
{{familytree | | | | | | | | | | | | D01| | D02 | | D03 | | D04 |D01= Infectious rhinitis|D02=[[Vasomotor rhinitis]]|D03= Gustatory rhinitis|D04= Nonallergic rhinitis wth eosinophilia syndrome<br>(NARES)}} | |||
{{familytree | | | | | | | | | |,|-|-|^|-|-|.| | | | | | | | | | |}} | |||
{{familytree | | | | | | | | | |!| | | | | |!|| | | | | | | | | |}} | |||
{{familytree | | | | | | | | | E01| | | |E02| | | | | | | | | |E01=Acute [[Rhinosinusitis]]|E02=Chronic [[Rhinosinusitis]]}} | |||
{{familytree/end}} | |||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
[[Category:Otolaryngology]] | |||
[[Category:Immunology]] | |||
Latest revision as of 00:00, 30 July 2020
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Rhinitis laboratory findings On the Web |
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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
The accurate diagnosis of rhinitis is highly dependent on a thorough history taking and physical examination. Laboratory investigations are never used solely for the diagnosis of rhinitis, but are often used in conjunction with the history and physical examination findings.
Laboratory Findings
The presenting symptoms of allergic and nonallergic rhinitis are sometimes difficult to distinguish, and it is often a diagnostic challenge to determine the etiology of rhinitis, whether it is allergic or nonallergic (or even an overlap of the two conditions).[1] The accurate diagnosis allergic rhinitis relies on the clinical history, and the demonstration of the presence of allergic sensitization towards relevant allergens.[2][3] Nonallergic rhinitis is a heterogeneous condition with a wide range of nasal pathological findings, which may require more targeted investigations.[4] Allergy investigations are never used alone for diagnosis because of the low specificity, and the test result should be interpreted in conjunction with the clinical history.[2]
Laboratory Confirmation of Allergic Rhinitis: Allergic rhinitis can be confirmed by recording specific IgE reactivity to relevant aeroallergens in the patient's history. This can be done via the following methods:[2][5][4][6]
- Skin test (skin-prick or intradermal):The skin test yield result within minutes and are often preferred. Temporary stoppage of antihistamine use is required before skin testing.
- RAST (radioallergosorbent test): This is a blood test that detect specific IgE antibodies using radioimmunoassay test. It is less cost effective compared to the skin-prick test and takes several days to obtain the result. RAST is a preferred test in patients with the following:
- Dermographism
- Severe atopic dermatitis
- Lack of willingness to temporarily stop antihistamine use.
- Nasal allergen challenge: This is not routinely done. It is usually used in research and in the diagnosis of occupational rhinitis.
- Total serum IgE and circulating eosinophil counts are not used for diagnosis of allergic rhinitis due to the lack of sensitivity and specificity.
| Rhinitis | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Positive Skin test or RAST test | Negative Skin test or RAST test | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Allergic Rhinitis | Nonallergic Rhinitis | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Infectious rhinitis | Vasomotor rhinitis | Gustatory rhinitis | Nonallergic rhinitis wth eosinophilia syndrome (NARES) | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Acute Rhinosinusitis | Chronic Rhinosinusitis | ||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Settipane RA, Charnock DR (2007). "Epidemiology of rhinitis: allergic and nonallergic". Clin Allergy Immunol. 19: 23–34. PMID 17153005.
- ↑ 2.0 2.1 2.2 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.
- ↑ 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.
- ↑ 4.0 4.1 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.
- ↑ Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR; et al. (2015). "Clinical practice guideline: Allergic rhinitis". Otolaryngol Head Neck Surg. 152 (1 Suppl): S1–43. doi:10.1177/0194599814561600. PMID 25644617.
- ↑ 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.