Diagnosis
4
Table 3. History and Physical Findings in AR
Presenting Symptoms Historical Findings Physical Findings
• Nasal congestion
• Sneezing
• Rhinorrhea (clear or
colored may exist, though
colored rhinorrhea may
indicate a comorbid
disease process with AR)
• Itching of nose, eyes,
palate
• Postnasal drip
• Frequent throat clearing
• Cough
• Malaise (may be
presenting complaint
in children)
• Fatigue (may be
presenting complaint
in children)
• Seasonal vs. perennial
nature of symptoms
• Symptoms on exposure to
particular agent (animals,
particular plants)
• Current medications
• Family history of atopic
or allergic disease
• Symptoms on exposure to
irritants (makes allergic
etiolog y less likely)
• Symptoms of upper
respiratory infection
(makes allergic etiolog y
less likely)
• Clear rhinorrhea (clear or
colored may exist, though
colored rhinorrhea may
indicate a comorbid
disease process with AR)
• Bluish or pale swelling of
nasal mucosa
• Ocular findings (watery
discharge, swollen
conjunctivae, scleral
injection)
• Frequent throat clearing
• Allergic shiners
• Nasal crease
• Absence of foreign
body, tumor, purulence
suggesting infection
Table 4. IgE-Specific Tests
Recommendation Advantages Disadvantages
Skin Tests
- Skin prick or
intradermal
Recommend • Allows for direct
observation of the body's
reaction to a specific
antigen
• Considered more sensitive
than blood testing
• Intradermal can be used
when additional sensitivity
is required, or skin prick
negative
• Less expensive than blood
testing
• Possible systemic
allergic reaction
(anaphylaxis)
• May be affected
by patient
medications
Blood testing
- Allergen
specific IgE
Recommend • No risk of anaphylaxis
• Not affected by patient's
medications
• Can be used for patients
with skin conditions such
as dermatographism or
severe eczema
• Can be used for patients
on beta-blockers or
with comorbid medical
conditions that preclude
skin testing
• Requires reliable
lab
• Potential for lab
errors
