Allergic rhinitis

Background

Allergic Rhinitis (also called hay fever) is inflammation of the nasal mucosa secondary to allergens in the air.

Clinical Features

• Patient present with a constellation of symptoms
  • thin clear rhinorrhea (if thick or discolored, consider infectious causes)
  • sneezing
  • itching of the nose
  • nasal congestion
  • nasal obstruction
  • clogged feeling in the ears
• triggers often easily identified
  • animals
  • season changes
• symptoms last until triggers are removed
• should not have fevers

Differential Diagnosis

• viral upper respiratory infection
• bacterial upper respiratory infection
• acute sinusitis
• chronic sinusitis
• fungal sinusitis
• nasal polyposis
• nasal mass
• nasal foreign body

Evaluation

• Exam
  • Ears- may see a serous otitis media, AOM
  • Eyes- watery
  • Nose
    • clear rhinorrhea
    • enlarged erythematous, shiny inferior turbinates (can see using an otoscope with an ear tip)
    • erythema around the alar cartilage (from whiping, nose blowing)
    • transverse nasal crease from the allergic solute or nasal solute- the act of rubbing the nose with the palm of the hand in an upward motion

References

Authors

Jay, Michael Holtz