A comprehensive diagnostic approach to upper airway disease

Abstract

The diagnosis of allergic rhinitis depends primarily on a good medical history and physical examination; in some cases, allergy testing is also needed. The most important of these is the history. Epidemiologic studies have been performed to identify the prevalence of allergic rhinitis, both seasonal rhinitis and perennial rhinitis, and to identify the various symptoms of which patients complain.1-3 These studies have also obtained information regarding patients’ perceptions of factors that provoke their rhinitis. However, patients with rhinitis may react to nonallergic irritants, such as airborne particulates, chemicals, or odors, and a patient’s history of triggering factors may include allergic and nonallergic triggers. Thus the physician must be knowledgeable regarding which triggers cause an allergic reaction and which do not. The physician who takes the history should know the various allergens in the local and regional environment and their various seasonalities.4 In general, tree pollens come out in the spring, grass pollens in the spring and the early summer, and weeds in the midsummer and the fall. Mold spores vary at different times of the year, and indoor allergens are present at all times. The treating physician must have this knowledge so that history taking can be put into the proper context and the patient’s symptoms can be correlated with seasonal allergens. Not only should the pollens of trees, grasses, and weeds be considered, but mold spores can be significant triggers in patients with perennial allergic rhinitis, as can indoor animal allergens, dust mite allergen, and cockroach and other insect allergens.