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Defining a diagnostic marker: a pragmatic requirement

The prediction of allergic rhinitis (AR) by nasal endoscopy represents an intriguing challenge for ear-nose-throat specialists. Hamizanand colleagues have attempted to determine the diagnostic characteristics of middle turbinate edema as a marker of inhalant allergy.1 In their study, middle turbinate edema was considered able to predict AR by demonstrating an excellent positive predictive value. However, we believe their study has some drawbacks. The AR diagnosis is based on the consistency between sensitization and symptom occurrence after exposure to the sensitizing allergen.2 From a statistical point of view, there are 4 main concerns: