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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

Neoplasm

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
Author

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.

Acknowledgements

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.

References
  1. Hand L. First-year allergen exposures may reduce later risks. Medscape Medical News. June 11, 2014. [Full Text].

  2. Lynch SV, Wood RA, Boushey H, Bacharier LB, Bloomberg GR, Kattan M, et al. Effects of early-life exposure to allergens and bacteria on recurrent wheeze and atopy in urban children. J Allergy Clin Immunol. 2014 May 28. [Medline].

  3. Meltzer EO. Productivity costs of antihistamines in the workplace. Occup Health Saf. 1996 Aug. 65(8):46-50. [Medline].

  4. [Guideline] World Health Organization (WHO). Allergic rhinitis and its impact on asthma. 2008. [Full Text].

  5. Crystal-Peters J, Neslusan C, Crown WH, Torres A. Treating allergic rhinitis in patients with comorbid asthma: the risk of asthma-related hospitalizations and emergency department visits. J Allergy Clin Immunol. 2002 Jan. 109(1):57-62. [Medline].

  6. Gendo K, Larson EB. Evidence-based diagnostic strategies for evaluating suspected allergic rhinitis. Ann Intern Med. 2004 Feb 17. 140(4):278-89. [Medline].

  7. Malone DC, Lawson KA, Smith DH, Arrighi HM, Battista C. A cost of illness study of allergic rhinitis in the United States. J Allergy Clin Immunol. 1997 Jan. 99(1 Pt 1):22-7. [Medline].

  8. Herr M, Clarisse B, Nikasinovic L, et al. Does allergic rhinitis exist in infancy? Findings from the PARIS birth cohort. Allergy. 2011 Feb. 66(2):214-21. [Medline].

  9. Hatzler L, Panetta V, Lau S, Wagner P, Bergmann RL, Illi S, et al. Molecular spreading and predictive value of preclinical IgE response to Phleum pratense in children with hay fever. J Allergy Clin Immunol. 2012 Jul 25. [Medline].

  10. Söderström L, Lilja G, Borres MP, Nilsson C. An explorative study of low levels of allergen-specific IgE and clinical allergy symptoms during early childhood. Allergy. 2011 Aug. 66(8):1058-64. [Medline].

  11. Cox LS, Larenas Linnemann D, Nolte H, Weldon D, Finegold I, Nelson HS. Sublingual immunotherapy: a comprehensive review. J Allergy Clin Immunol. 2006 May. 117(5):1021-35. [Medline].

  12. Compalati E, Penagos M, Tarantini F, Passalacqua G, Canonica GW. Specific immunotherapy for respiratory allergy: state of the art according to current meta-analyses. Ann Allergy Asthma Immunol. 2009 Jan. 102(1):22-8. [Medline].

  13. FDA OKs Oralair, First US Sublingual Allergy Immunotherapy. Medscape. Available at http://www.medscape.com/viewarticle/822975. Accessed: April 4, 2014.

  14. Grastek [package insert]. Whitehouse Station, NJ: Merck & Co, Inc. April 2014. Available at [Full Text].

  15. Maloney J, Bernstein DI, Nelson H, Creticos P, Hébert J, Noonan M, et al. Efficacy and safety of grass sublingual immunotherapy tablet, MK-7243: a large randomized controlled trial. Ann Allergy Asthma Immunol. 2014 Feb. 112(2):146-153.e2. [Medline].

  16. Aaronson DW. Side effects of rhinitis medications. J Allergy Clin Immunol. 1998 Feb. 101(2 Pt 2):S379-82. [Medline].

  17. Allergies in America. Allergies in America Executive Summary. myallergiesinamerica. Available at http://www.myallergiesinamerica.com/pdfs/myaia.pdf. Accessed: June 2007.

  18. Brooks M. FDA OKs carbinoxamine ER for allergic rhinitis in children. Medscape Medical News. April 3, 2013. Available at http://www.medscape.com/viewarticle/781921. Accessed: April 8, 2013.

  19. Busse W. Allergic rhinitis: charting a course for the 21st century. J Respir Dis. 1998. 19:S1-64.

  20. Day J. Pros and cons of the use of antihistamines in managing allergic rhinitis. J Allergy Clin Immunol. 1999 Mar. 103(3 Pt 2):S395-9. [Medline].

  21. Day JH, Briscoe M, Widlitz MD. Cetirizine, loratadine, or placebo in subjects with seasonal allergic rhinitis: effects after controlled ragweed pollen challenge in an environmental exposure unit. J Allergy Clin Immunol. 1998 May. 101(5):638-45. [Medline].

  22. Delafuente JC, Davis TA, Davis JA. Pharmacotherapy of allergic rhinitis. Clin Pharm. 1989 Jul. 8(7):474-85. [Medline].

  23. FDA approves Tris Pharma’s new drug application for Karbinal ER (carbinoxamine maleate) extended-release oral suspension [press release]. April 3, 2013. Available at http://www.trispharma.com/news_karbinal_apr2013.php. Accessed: April 8, 2013.

  24. Hemp P. Presenteeism: at work--but out of it. Harv Bus Rev. 2004 Oct. 82(10):49-58, 155. [Medline].

  25. Hussain I, Kline JN. DNA, the immune system, and atopic disease. J Investig Dermatol Symp Proc. 2004 Jan. 9(1):23-8. [Medline].

  26. LaForce C. Use of nasal steroids in managing allergic rhinitis. J Allergy Clin Immunol. 1999 Mar. 103(3 Pt 2):S388-94. [Medline].

  27. Lange B, Lukat KF, Rettig K, Holtappels G, Bachert C. Efficacy, cost-effectiveness, and tolerability of mometasone furoate, levocabastine, and disodium cromoglycate nasal sprays in the treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol. 2005 Sep. 95(3):272-82. [Medline].

  28. Ledford DK, Lockey RF. Allergic rhinitis: understanding the process. J Respir Dis. 1998. 19(7):576-84.

  29. Middleton E, Reed C, Ellis E. Allergic and non-allergic rhinitis. Allergy: Principles and Practice. 5th ed. Mosby-Year Book; 1998. Vol 2: Chapter 70.

  30. Naclerio R, Solomon W. Rhinitis and inhalant allergens. JAMA. 1997 Dec 10. 278(22):1842-8. [Medline].

  31. Plevkova J, Brozmanova M, Pecova R, Tatar M. Effects of intranasal histamine on the cough reflex in subjects with allergic rhinitis. J Physiol Pharmacol. 2005 Sep. 56 Suppl 4:185-95. [Medline].

  32. Settipane RJ, Hagy GW, Settipane GA. Long-term risk factors for developing asthma and allergic rhinitis: a 23-year follow-up study of college students. Allergy Proc. 1994 Jan-Feb. 15(1):21-5. [Medline].

  33. Spector S. Pathophysiology and pharmacotherapy of allergic rhinitis. Foreword. J Allergy Clin Immunol. 1999 Mar. 103(3 Pt 2):S377. [Medline].

  34. Sublett JL. The environment and risk factors for atopy. Curr Allergy Asthma Rep. 2005 Nov. 5(6):445-50. [Medline].

  35. Wahn U, Klimek L, Ploszczuk A, Adelt T, Sandner B, Trebas-Pietras E, et al. High-dose sublingual immunotherapy with single-dose aqueous grass pollen extract in children is effective and safe: A double-blind, placebo-controlled study. J Allergy Clin Immunol. 2012 Aug 29. [Medline].

  36. Wahn U, Tabar A, Kuna P, et al. Efficacy and safety of 5-grass-pollen sublingual immunotherapy tablets in pediatric allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2009 Jan. 123(1):160-166.e3. [Medline].

  37. Wheeler PW, Wheeler SF. Vasomotor rhinitis. Am Fam Physician. 2005 Sep 15. 72(6):1057-62. [Medline].

 
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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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