Rhinitis laboratory findings: Difference between revisions
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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" /> | ||
'''Diagnosis 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="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 prick test- This is a sensitive test which is easy to use, yields result within 15minutes and it is often the preferred test. | * Skin prick test- This is a sensitive test which is easy to use, yields result within 15minutes and it is often the preferred test. Temporary stoppage of antihistamine use is required before the test. | ||
* RAST (radioallergosorbent test)- This is a blood test that detect specific IgE antibodies using radioimmunoassay 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: | ||
# Dermographism | |||
# Severe atopic dermatitis | |||
# Lack of willingness to temporarily stop antihistamine use. | |||
* ''Nasal allergen challenge''- This is not routinely done. It can be useful in some forms of occupational rhinitis. | * ''Nasal allergen challenge''- This is not routinely done. It can be useful in some forms 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. | * Total serum IgE and circulating eosinophil counts are not used for diagnosis of allergic rhinitis due to the lack of sensitivity and specificity. | ||
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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
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]
Diagnosis 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][4][5]
- Skin prick test- This is a sensitive test which is easy to use, yields result within 15minutes and it is often the preferred test. Temporary stoppage of antihistamine use is required before the 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 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 can be useful in some forms 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.
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.
- ↑ 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.