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Symptoms, nasal inspection poor at identifying allergic rhinitis

Clinical Question:
Can allergic rhinitis be reliably diagnosed by symptoms or nasal inspection via endoscopy?

Bottom Line:
Patient symptoms and nasal endoscopy findings do not reliably predict allergic rhinitis as documented by skin prick testing. Alhough turbinate color and hypertrophy are often used to make the diagnosis, agreement among 3 otolaryngologists in this study was low. (LOE = 1c)

Reference:
Eren E, Akta? A, Arslano?lu S, et al. Diagnosis of allergic rhinitis: inter-rater reliability and predictive value of nasal endoscopic examination: a prospective observational study. Clin Otolaryngol 2013;38(6):481-486.  [PMID:23981854]

Study Design:
Cohort (prospective)

Funding:
Self-funded or unfunded

Setting:
Outpatient (specialty)

Synopsis:
This study, conducted by Turkish otolaryngologists, enrolled 108 consecutive adult patients referred from an allergy clinic for further evaluation of symptoms of possible allergy. Patients were not receiving treatment at the time of evaluation. All patients were evaluated by history and nasal endoscopy, and then had skin prick testing for 27 aeroallergens; one or more positive reactions, which occurred in 60.1%, served to make the diagnosis of allergic rhinitis. Independently, typical symptoms of allergic rhinitis were not predictive of the diagnosis, including rhinorrhea, sneezing, itching, nasal obstruction, postnasal drip, smell dysfunction, cough, or dysphonia. Overall, endoscopic determination of allergic rhinitis was low to moderate. Inter-rater reliability among three physicians performing nasal endoscopy was moderate for the presence of mucosal edema (Fleiss’ kappa = .48) and polypoid degeneration of inferior turbinate tail (.48), significant for septal deviation (.65), and high for the presence of nasal polyps (.96). Other measures had low reliability: nasal secretion characteristics, turbinate hypertrophy, and turbinate color. The reference standard -- skin testing to 27 allergens -- may not be robust enough to draw firm conclusions, but it seems that there is a low correlation between physical examination findings and documented allergy.

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