How is it Diagnosed?
Upper airway allergic diseases, such as allergic rhinitis, are diagnosed based on clinical
history, physical examination, and specific allergy testing. Patients typically present
with symptoms like sneezing, nasal congestion, rhinorrhea, postnasal drip, itchy eyes,
and throat irritation.
A thorough history is crucial and includes inquiries about symptom patterns (seasonal
vs. perennial), potential triggers (dust, pollen, pets), family history of atopy, and
response to antihistamines. Physical examination may reveal pale, edematous nasal
turbinates, clear nasal discharge, and allergic shiners (dark circles under the eyes).
Skin prick tests (SPT) are a standard diagnostic tool, where small amounts of allergens
are introduced into the skin to detect hypersensitivity reactions. Positive wheal-andflare responses confirm allergen sensitivity. Alternatively, serum-specific IgE testing
(e.g., RAST) can identify allergen-specific antibodies, useful for patients who cannot
undergo SPT.
Nasal cytology can also support diagnosis by showing eosinophilic infiltration in nasal
secretions. In certain cases, nasal endoscopy may be done to rule out structural
abnormalities or chronic sinusitis.
Differentiation from non-allergic rhinitis, infections, or other nasal pathologies is
important. A combination of patient history, clinical signs, and targeted testing
facilitates accurate diagnosis and guides appropriate management, including allergen
avoidance, pharmacotherapy, and immunotherapy.