Pediatric Allergic Rhinitis Workup

  • Author: Jack M Becker, MD; Chief Editor: Harumi Jyonouchi, MD   more...
 
Updated: Mar 28, 2012
 

Laboratory Studies

No studies are needed in allergic rhinitis (AR) if the patient has a straightforward history. When the history is confusing, various studies are helpful, including the following:

  • Nasal smear: Eosinophils usually indicate allergy. Neutrophils are more indicative of an infectious process, such as sinusitis.
  • CBC count with differential: A CBC count may reveal an increased number of eosinophils. An eosinophil count within the reference range does not exclude allergic rhinitis; however, an elevated eosinophil count is suggestive of the diagnosis.
  • Immunoglobulin E (IgE): Serum IgE values are not routinely recommended to evaluate atopy. An IgE value within the reference range does not exclude allergic rhinitis; however, an elevated IgE value is suggestive of the diagnosis. Allergen-specific IgE testing, also known as radioallergosorbent test (RAST), can be helpful if a specific allergen is suspected. Screening of a large number of allergens can cause confusion because of the possibility of false positives. This is especially true for IgE food allergy testing. The results of one explorative study found that low levels of serum IgE can be detected from age 6 months. The study suggests that detectable levels of IgE sensitization are associated with present symptoms of eczema, rhinitis, asthma, and food and inhalant allergens and may also be predictive of future allergic symptoms.[7]
  • Skin prick testing: This test is highly sensitive and specific for aeroallergens.
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Imaging Studies

  • Imaging studies are not needed unless sinusitis is suspected, in which case, a limited CT scan of the sinuses (without contrast) is indicated.
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Other Tests

  • RAST for common allergens can be used to identify the patient's triggers. These might include dust mites, cat dander, dog dander, grass pollens, tree pollens, weed pollens, and molds.
  • Foods rarely cause allergic rhinitis, and tests for food allergies are not indicated in patients with allergic rhinitis.
  • RAST testing for allergens, such as dust mites, cat dander, and dog dander, is almost as sensitive and specific as allergen skin testing.
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Procedures

  • Skin testing to identify the triggering agent
    • Skin testing has high sensitivity and specificity and is the preferred method of quick allergen identification for aeroallergens.
    • Skin testing is helpful if the allergens can be eliminated from the patient's environment or if the patient can avoid them.
    • Skin testing is extremely helpful when patients are unresponsive to standard therapy or are unwilling to acknowledge the trigger, which is especially true if the family pet is a possible trigger.
    • Skin testing is required if the patient is interested in allergen immunotherapy.
  • Rhinoscopy: This is helpful in direct examination of the upper airway in identifying whether the etiology of rhinitis is obstructive or infectious and for evaluation of nasal polyposis.
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Contributor Information and Disclosures
Author

Jack M Becker, MD  Clinical Associate Professor of Pediatrics, Drexel University School 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, and American College of Allergy, Asthma and Immunology

Disclosure: gsk Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Ivax Honoraria Speaking and teaching

Specialty Editor Board

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

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

Disclosure: Nothing to disclose.

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.

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.

David Pallares, MD  Clinical Assistant Professor, Department of Pediatrics, Division of Allergy and Immunology, University of Louisville School of Medicine

David Pallares, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology

Disclosure: Nothing to disclose.

Chief Editor

Harumi Jyonouchi, MD  Associate Professor, Division of Pulmonary, Allergy/Immunology, and Infectious Diseases, Department of Pediatrics, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

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 Mucosal Immunology, and Society for Pediatric Research

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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