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Common symptoms of rhinitis can include:7
Approximately 65 percent of patients diagnosed as having allergic rhinitis and prescribed a non-sedating antihistamine are not allergic.7,8 As allergic rhinitis and non-allergic rhinitis have such similar symptoms, but different management, it is imperative to correctly diagnose the cause and select the correct management.9
Fortunately, guidelines provide a foundation for the process of diagnosing allergic rhinitis, which starts with a physical examination and an allergy-focused patient history.1,5
Guided by the findings of an allergy-focused patient history, you can continue to work through the most appropriate next steps, which may include specific IgE tests. Skin-prick testing (SPT) and specific IgE blood testing can help you determine allergen sensitization, which may give you the ability to correctly diagnose and improve clinical management.10,11 The patient medical history should be supplemented by allergen testing for accurate results.12
It is important to consider allergic rhinitis in patients with asthma, atopic dermatitis (eczema), conjunctivitis, sinusitis, polyposis, upper respiratory tract infections, otitis media, sleeping disorders, and in children with learning and attention impairments.
More than 80 percent of people with asthma also suffer from rhinitis,7 suggesting the concept of “one airway, one disease.”13,14 The presence of allergic rhinitis commonly exacerbates asthma, increasing the risk of asthma attacks, emergency visits, and hospitalizations for asthma. It is not clear whether allergic rhinitis represents an earlier clinical manifestation of allergic disease in atopic patients who will later develop asthma or whether rhinitis itself is causative for asthma.14-17
If your patient suffers from allergic rhinitis triggered by pollen and has an allergic reaction that typically occurs upon ingestion of certain foods, he or she may be experiencing pollen food allergy syndrome (PFAS), also known as oral allergy syndrome (OAS).5
In a UK general practice survey of adults with asthma and comorbid allergic rhinitis (n=4,611), versus patients with asthma alone (n=22,692), the presence of concomitant allergic rhinitis with asthma increases the following:20
Rhinitis significantly reduces quality of life and results in substantial healthcare costs.5,18,19 As such, there are several valid reasons to consider a specific IgE serological test, including:
These symptoms are often triggered by seasonal and perennial allergies, including:5
Adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis to 90 percent.i,ii Conventionally, a diagnosis of allergic or autoimmune disease relies on the case history and a physical examination. However, adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis.i,ii Diagnostic testing can also help to improve the patient’s quality of life and productivity, reduce costs associated with absenteeism, and optimize use of medication, in addition to decreasing unscheduled healthcare visits.iii,iv
i. Duran-Tauleria E, Vignati G, Guedan MJ, et al. The utility of specific immunoglobulin E measurements in primary care. Allergy. 2004;59 (Suppl78):35-41.
ii. NiggemannB, Nilsson M, Friedrichs F. Paediatric allergy diagnosis in primary care is improved by in vitro allergen specific IgE testing. Pediatr Allergy Immunol. 2008;19:325-331
iii. Welsh N, et al. The Benefits of Specific Immunoglobulin E Testing in the Primary Care Setting. J Am Pharm Assoc. 2006;46:627.
iv. Szeinbach SL, Williams B, Muntendam P, et al. Identification of allergic disease among users of antihistamines. J Manag Care Pharm. 2004; 10 (3): 234-238
Guidelines suggest that one of the first steps in managing and caring for patients with allergic rhinitis (AR) is to classify their disease, based on symptom duration and severity. AR is a major chronic respiratory disease due to its prevalence, impact on quality of life, and relationship to asthma. AR affects physical and psychological well-being by reducing sleep quality that in turn negatively impacts work performance and productivity, school attendance and concentration, and the patient’s social life.18,21
The management of AR consists of three major categories of treatment:
1. Allergen avoidance and environmental control measures
2. Pharmacological management
Practice parameters have been developed to classify and manage treatment of AR and guideline-directed management has been shown to improve disease control.18,21
Symptoms are classified as intermittent or persistent, and mild or moderate to severe. Optimal treatment includes allergen avoidance and pharmacotherapy. Immunotherapy and asthma evaluation should be considered when appropriate. AR is worth treating effectively, as when it is poorly controlled, it can impact daily activities, quality of life, and other areas of the respiratory tract, such as ears, sinuses, throat, and lungs.18,21