Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

Allergic Rhinitis 93

Allergic Rhinitis......................................

PAMELA DAFFERN, MD

history & physical

History

■Personal or family history of atopic dermatitis, allergic rhinitis, or

asthma (∼15% of population)

■Seasonal symptoms, especially while outdoors during pollen season,

usually due to plant pollens or molds

■Perennial symptoms, often worse upon arising, usually due to dust

mites or other insect allergens, molds, animal allergens, or occupa-

tional exposure

Signs & Symptoms

■Acute: nasocular itching, tearing, rhinorrhea, repetitive sneezing,

nasal blockage

■Chronic: postnasal drainage & congestion

■Ocular signs include conjunctival injection, chemosis, “allergic shin-

ers”

■External nasal crease indicative of nasal itching (“allergic salute”)

■Nasal exam reveals pale, boggy nasal mucosa w/ clear secretions,

enlarged turbinates, narrowed nasal airway

■Chronic mouth breathing may lead to high-arched palate & microg-

nathia

tests

■CBC may reveal peripheral eosinphilia

■Nasal smear reveals metachromatic cells & eosinophils, useful for

distinguishing allergic from other forms of rhinitis

■Identify specific IgE antibodies to suspected allergens by skin testing

or in vitro (RAST) tests. These are helpful when they corroborate the

history of exposure.

differential diagnosis

■Infectious rhinitis: viral or bacterial

■Vasomotor rhinitis: nonspecific triggers (cold air, odors)

■Nasal polyps

■Rhinitis medicamentosa: OTC decongestants or cocaine

■Hormonal rhinitis: thyroid disorders, menopausal

■Wegener’s granulomatosis