Allergic Rhinitis (Hay Fever and Rose Fever) and Chronic Nasal Congestion

Description

Alternative Names

Diagnosis

To determine the cause of rhinitis, the physician will ask a number of questions. They may include the following:

• The time of day and year of rhinitis episodes. Rhinitis that appears seasonally is almost always due to pollens and outdoor allergens. If symptoms occur throughout the year, the physician will suspect perennial allergic or non-allergic rhinitis.
• Whether a family history of allergies is present.
• If there is a history of medical problems.
• In women, whether they are pregnant or taking estrogen containing agents (oral contraceptives, hormone replacement therapy).
• If the patient is taking any other medications, including on-going decongestants (which could be causing a rebound effect).
• If the patient owns pets.
• Any additional unusual symptoms. As examples, bloody nasal discharge and obstruction in only one nasal passage could suggest a tumor. Or swelling or tingling of the lips after eating raw stoned-fruit may indicate seasonal allergies. Fatigue, sensitivity to cold, weight gain and depression may be signs of hypothyroidism.

Physical Examination

The physician will usually examine the inside of the nose with an instrument called a speculum. This is a painless examination and allows the doctor to check for redness and other signs of inflammation. The doctor will also usually check the eyes, ears, and chest.

Allergy Skin Tests

A skin test is a simple method for detecting common allergens. Patients usually are tested for a panel of common allergens. Skin tests are rarely needed to diagnose mild seasonal allergic rhinitis, since the cause is usually obvious. The test is not appropriate for children less than three years old.

The procedure is as follows:

• Patients should not take antihistamines for at least 12 to 72 hours before the test. Otherwise an allergic reaction may not show up.
• Small amounts of suspected allergens are applied to the skin with a needle prick or scratch or are injected a few cells deep into the skin. The latter test may be more sensitive than the standard prick test.
• If an allergy is present, a hive (a swollen reddened area) forms within about 20 minutes.

The test is not completely accurate. For instance, a 2001 study reported that testing detected allergies in less than half of children with rhinitis. Furthermore, about 15% to 20% of people may have a skin reaction without actually having an allergy.

Laboratory Tests

Nasal Smear. The physician may take a nasal smear. The nasal secretion is examined microscopically for factors that might indicate a cause, such as increased numbers of white blood cells, indicating infection, or high counts of eosinophils. (High eosinophil counts indicate an allergic condition, but low counts do not rule out allergic rhinitis.)

Tests for IgE. Blood tests for IgE immunoglobulin production may also be performed. One called the radioallergosorbent Test (RAST) is used to detect increased levels of allergen-specific IgE in response to particular allergens. Blood tests for IgE may be less accurate than skin tests. They should only be performed on patients who cannot undergo skin testing or when skin test results are uncertain.

Imaging Tests

In people with chronic rhinitis, the physician may also check for sinusitis. Imaging tests may be useful if other tests are ambiguous.

• A test called transillumination, in which a physician shines a bright light against the patient's cheek or forehead, is an inexpensive method for checking for abnormalities in the sinus cavities, although not highly accurate.
• X-rays and CT scans may be useful for some cases of sinusitis.

Click the icon to see an image of a CT scan.

Nasal Endoscopy

In certain cases of chronic or unresponsive seasonal rhinitis, a physician may use endoscopy to examine for any irregularities in the nose structure. Endoscopy employs a tube inserted through the nose that contains instruments and a miniature camera to view the passageways.