Consequences of misdiagnosing allergic rhinitis

Brosius WA. Am J Nurse Pract. 2005;9(4):35-44.

Summary
Allergic rhinitis affects millions of people in the United States and around the world. Nevertheless, only 30% to 45% of patients with allergic rhinitis are diagnosed with the condition by a healthcare professional, notably a physician or nurse practitioner (NP). Even for well-trained providers, correctly diagnosing inhalant allergies on the basis of symptoms, patient history, and physical examination—without diagnostic testing—is a challenge. In fact, a complete history-plus-physical in patients with nasal symptoms provides an accurate diagnosis of allergy in only about 50% of cases. Patients cannot be expected to match even this level of diagnostic accuracy because they do not have the expertise to differentiate allergic from nonallergic disorders, identify specific allergens, or assess comorbid conditions. And yet, they can decide that they have an allergic disorder, select a treatment based perhaps on an advertisement, a TV commercial, or a friend’s recommendation, and purchase this treatment, an over-the-counter (OTC) nonsedating antihistamine (NSA) or one of several sedating antihistamines, at their local pharmacy or supermarket.

This article examines the possibility of misdiagnosis of allergic rhinitis and some of the likely consequences. It also underscores for NPs the importance of proper diagnosis and treatment.

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