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Pediatric Allergic Rhinitis Differential Diagnoses

  • Author: Jack M Becker, MD; Chief Editor: Harumi Jyonouchi, MD  more...
Updated: May 04, 2016

Diagnostic Considerations

Inflammatory causes

Bottle feeding (children >18 mo)

Vasomotor rhinitis

Viral infection

Obstructive causes

Adenoid hyperplasia

Choanal atresia

Foreign body

Deviated septum

Nasal polyps


Oral allergy syndrome

Oral allergy syndrome (OAS), also known as pollen-food syndrome, occurs when the body perceives certain foods, primarily fruits and vegetables, as an allergen and causes a contact dermatitis reaction in the mouth. This is often due to cross-reactivity between pollens and fruit/vegetable allergens. These food allergens are heat labile and easily lose their allergenicity with heating. Thus, patients with this condition report an itchy mouth when eating certain fruits or vegetables in their natural form. For example, eating a whole fresh apple causes a reaction, but eating apple pie or apple sauce or drinking apple juice does not.

The most common pollens associated with OAS include birch and ragweed pollens. Birch tree pollen cross-reacts with apple, pear, peach, celery, and carrots. Ragweed cross-reacts with melon, watermelon, cantaloupe, honeydew, zucchini, and cucumber.

Making the proper diagnosis is important because OAS can be confused with a potentially life-threatening anaphylactic reaction to food allergens. Studies have shown that use of allergen immunotherapy decreases or eliminates this reaction.

Differential Diagnoses

Contributor Information and Disclosures

Jack M Becker, MD Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Jack M Becker, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma and Immunology

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: TEVA Pharmaceuticals.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Harumi Jyonouchi, MD Faculty, Division of Allergy/Immunology and Infectious Diseases, Department of Pediatrics, Saint Peter's University Hospital

Harumi Jyonouchi, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association of Immunologists, American Medical Association, Clinical Immunology Society, New York Academy of Sciences, Society for Experimental Biology and Medicine, Society for Pediatric Research, Society for Mucosal Immunology

Disclosure: Nothing to disclose.

Additional Contributors

C Lucy Park, MD Chief, Division of Allergy, Immunology, and Pulmonology, Associate Professor, Department of Pediatrics, University of Illinois at Chicago College of Medicine

C Lucy Park, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, Chicago Medical Society, American Medical Association, Clinical Immunology Society, Illinois State Medical Society

Disclosure: Nothing to disclose.


John Wilson Georgitis, MD Consulting Staff, Lafayette Allergy Services

John Wilson Georgitis, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association for the Advancement of Science, American College of Chest Physicians, American Lung Association, American Medical Writers Association, and American Thoracic Society

Disclosure: Nothing to disclose.

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Photo demonstrates the allergic salute, which is the action performed when a patient rubs the nose using a motion across the nose.
Photo demonstrates allergic shiners. Note the periorbital edema and bluish discoloration seen in allergic rhinitis and sinusitis.
Impact of nasal allergies.
How patient feel when they have allergy symptoms.
Nasal symptoms and affect on work performance.
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