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Allergic rhinitis (AR), non-allergic rhinitis, and sinusitis pose
an important diagnostic challenge for the primary care clinician.
Despite different etiologies, these conditions share three common
confounding symptoms of nasal congestion, increased secretions, and
rhinorrhea (runny nose).
Effective symptom management requires an accurate diagnosis. Unfortunately,
rhinitis is easy to diagnose but harder to diagnose differentially
than once thought. The prevalence of allergic and nonallergic rhinitis
are more or less the same, as only 50% of all rhinitis is truly allergic,
the rest being non-allergic.1 AR
appears overdiagnosed using only patient history and physical alone.
A study at Ohio State University showed that, among patients taking
prescription antihistamines for presumed AR, 65% (or two out of three)
were not allergic,2 and
prescription antihistamines don’t typically work in non-allergic
conditions.3 Experts
agree that accurate diagnosis and treatment of allergy-like upper
respiratory symptoms requires objective evidence of the presence
or absence of atopy.2,4,5
When used with the history and physical, ImmunoCAP
specific IgE blood testing offers primary care clinicians a
valuable tool to help rule atopy in or out, aid accurate diagnosis,
and guide management (through
avoidance, treatment selection, or timely referral).
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