Login to continue where you left off or register to access the accredited modules
By the end of this chapter, participants will be able to:
recall the impact of allergic rhinitis on patients’ quality of life and the need for an important and accurate diagnosis
describe the diagnostic work-flow and tests available to support the diagnosis of allergic rhinitis
explain how component-resolved diagnostics may aid the diagnosis and management of allergic rhinitis.
Rhinitis is a nasal symptomatic disorder caused by inflammation of the nasal mucosa1 that can be driven by various elements, including allergens and infections.2
Allergic rhinitis is defined as a nasal symptomatic disorder induced after allergen exposure by IgE-mediated inflammation.3
It is estimated that 100 million Europeans suffer from allergic rhinitis.4
According to the Allergic Rhinitis Impact on Asthma (ARIA) Guidelines, allergic rhinitis can be classified into the following categories:3
Common triggers of allergic rhinitis5
Several allergen sources, seasonal (s) or perennial (p), are associated with allergic rhinitis:
What symptoms must a GP look out for when diagnosing a patient with allergic rhinitis?
Clinical symptoms of allergic rhinitis6
Ocular symptoms occur in 50–70% of people with allergic rhinitis and differentiates it from other forms of rhinitis.7
Patients may also experience asthma-related symptoms, as rhinitis and asthma often co-exist in patients.8
Why is a correct diagnosis important?
Patients with allergic rhinitis and non-allergic rhinitis may share similar symptoms, for example, sneezing, nasal congestion, rhinorrhoea and nasal itching.9 and may require different treatment.10
Misdiagnosis can prevent the patient from receiving the most effective clinical management and therapies.
Allergic rhinitis is a risk factor for the development of asthma.11 Recommendations by ARIA suggest that patients diagnosed with allergic rhinitis should also be evaluated for asthma.3
A patient correctly diagnosed with allergic rhinitis may also benefit from being evaluated and effectively treated for asthma.
Symptoms associated with allergic rhinitis, such as sleeping disorders and poorer mental health, may have a significant impact on the patient’s quality of life.12,13
Early and correct diagnosis can significantly improve the patient’s wellbeing.
Recommended tests for allergic rhinitis
What diagnostic work-flow should clinicians follow for the diagnosis of allergic rhinitis?
Component-resolved diagnostics (CRD)
The use of CRD has been widely studied for the diagnoses of allergic rhinitis. For example:
Northern Sweden: In a population-based sample of school children, high-level sensitisation to cat, dog and horse components and sensitisation to multiple components within the same species were shown to have the strongest associations to asthma and rhinitis.19
CRD has also been shown to influence the selection of specific immunotherapy prescriptions to pollen-related allergies due more selective identification of disease-eliciting pollen sources.20
Use of dust mite components in patients with allergic rhinitis discriminated primary allergy and cross-reactivity in patients and identified patients who were better suited for immunotherapy.21
Several factors need to be considered when using CRD in patients with allergic rhinitis. For example:
Similar to other in vitro IgE tests, a positive result only shows sensitisation15
Medical history and the patient’s symptoms should be used to interpret all allergy-related results15
Common triggers of allergic rhinitis are pollen, house dust mite, mould and furry animals.
Allergic rhinitis and asthma often co-exist in patients – testing for other co-morbidities may be necessary if the history and examination is suggestive.
Allergen sensitisation testing in primary care should use in vitro testing.
Common triggering allergens reported for allergic rhinitis are also available for CRD testing.
Rowland-Seymour A. Decision Making in Medicine (Third Edition). 2010:32-3.
Rondón C. EAACI 2014 (Oral presentation).
Bousquet J et al. Allergy. 2008;63(Suppl 86):8–160.
EACCI: Advocacy Manifesto. June 2015.
Scadding GK et al. Clinic Experiment Allergy. 2008;38(1):19–42.
Greiner AN et al. Lancet. 2011;378(9809):2112–22.
Cingi C et al. Clin Transl Allergy. 2017;7(17):1–12.
Grossman J. Chest. 1997;11(4):837–1148.
Schroer B. Cleve Clin J Med. 2012;79(4):285–93.
Greiner AN, Meltzer EO. Proc Am Thorac Soc. 2011;8(1):121–31.
Guerra et al. Allergy Clin Immunol. 2002;109(3):419–25.
Craig TJ et al. J Allergy Clin Immunol. 2004;114(5):S139–45.
Leynaert B et al. Am J Respir Crit Care Med. 2000;162(4 Pt 1):1391–6.
Akdis C, Hellings P, Agache I (Editors). Global Atlas of Allergic Rhinitis and Chronic Rhinosinusitis. EAACI 2015: 151, 173
Portnoy JM. Missouri Medicine. 2011;108(5):339–43.
Nevis IF et al. Allergy Asthma Clin Immunol. 2016;12(20):1–12.
Auge J et al. J Allergy. 2017;73(8):1597–1608.
Bjerg A et al. Pediatr Allergy Immunol 2015;26(6):557–63.
Stringari G et al. J Allergy Clin Immunol 2014;134(1):75–81.e2.
Yadzir ZHM et al. Iran J Allergy Asthma Immunol. 2014;13(4):240–6.
This independent educational activity is supported by funding from Thermo Fisher Scientific. PCM Scientific is the medical education company acting as scientific secretariat and organiser for this programme. The activity is run independently of the financial supporter and all content is created by the faculty. No funder has had input into the content of the activity.