Pediatric Allergic Rhinitis Differential Diagnoses

Updated: Feb 10, 2022
  • Author: Jack M Becker, MD; Chief Editor: Harumi Jyonouchi, MD  more...
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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 to cross-reactive pollens decreases or eliminates this reaction.

Differential Diagnoses