immunology allergic disorders
Allergic Rhinitis
Diagnosis of Allergic Rhinitis
Clinical evaluation Occasionally skin testing, allergen-specific serum IgE tests, or both can frequently be diagnosed based on history alone. Diagnostic testing is not routinely needed unless patients do not improve when treated empirically; for such patients, Specific tests are done to identify a reaction to pollens (seasonal) or to dust mite feces, cockroaches, animal dander, mold, or other antigens (perennial), which can be used to guide additional treatment. Occasionally, skin test results are equivocal, or testing cannot be done (eg, because patients are taking drugs that interfere with results and cannot safely be withheld); then, an Specific tests is done. A nasal smear to detect eosinophils can be done to confirm allergic rhinitis. Although the test is rarely done anymore, it can be a useful alternative to needlesticks in children or used as an additional tool in the evaluation of rhinitis. The sensitivity and specificity of the test is not clear ( Diagnosis reference ). Eosinophilia detected on nasal smear plus negative skin tests suggests is usually also diagnosed based on history. Lack of a clinical response to treatment for assumed allergic rhinitis and negative results on skin tests and/or an allergen-specific serum IgE test also suggest a nonallergic cause; disorders to consider include nasal tumors, enlarged adenoids, hypertrophic nasal turbinates, Granulomatosis with Polyangiitis (GPA) , and 1.Pal I, Babu AS, Halder I, Kumar S: Nasal smear eosinophils and allergic rhinitis.Ear Nose Throat96 (10-11):E17–E22, 2017. doi: 10.1177/0145561317096010-1105 