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Rhinitis

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Rhinitis, Nasal Discharge, Rhinorrhea, Coryza

  • Causes
  • History
  1. Duration of symptoms <1 week
    1. Viral Rhinitis
    2. Allergic Rhinitis Exacerbation
  2. Chronic symptoms that follow pattern of triggers
    1. Seasonal or Perennial Allergic Rhinitis
    2. Other causes
      1. Drug-Induced Rhinitis
      2. Exercise-induced Rhinitis
      3. Gustatory Rhinitis or other food reactions
      4. Vasomotor Rhinitis
      5. Irritant Rhinitis
  3. Unilateral Rhinorrhea
    1. Choanal Atresia
    2. Nasal Foreign Body (especially in young children)
    3. Nasal Neoplasm
    4. Cerebrospinal Rhinorrhea
  4. Underlying medical conditions
    1. Hypothyroidism
    2. Rheumatoid conditions (e.g. SLE, Sjogren's Syndrome)
    3. Gastroesophageal Reflux
  • Examination
  1. Eyes
    1. Allergic Shiners
    2. Allergic Conjunctivitis
  2. Ears
    1. Eustachian Tube Dysfunction (chronic congestion)
  3. Nose
    1. Nose breathing difficult (chronic congestion)
    2. Deviated septum
    3. Nasal Polyps
    4. Purulent nasal drainage (Acute Sinusitis)
  4. Mouth
    1. Tonsil hypertrophy (Non-allergic Rhinitis)
  5. Neck
    1. Cervical Lymphadenopathy (Infectious Rhinitis)
  6. Respiratory
    1. Wheezing (Asthma and Atopic Triad)
  7. Skin
    1. Eczema (Atopic Triad)
  • Diagnostics
  1. Eosinophils on nasal drainage evaluation
    1. Suggests Allergic Rhinitis or Eosinophilia Syndrome
  2. Allergy evaluation
    1. Skin Testing for allergy
    2. RadioAllergoSorbent Test (RAST)
  • Differential Diagnosis
  1. Allergic Rhinitis
    1. Sneezing and Pruritus with seasonal variation
    2. Pale, boggy nasal mucosa
    3. Family History of Allergic Rhinitis or atopy
    4. Allergen exposure or positive Allergy Testing
  2. Non-allergic Rhinitis
    1. See Rhinitis Causes
    2. Perennial symptoms
    3. Post-nasal drainage
    4. Erythematous nasal mucosa
    5. Irritant exposure and negative Allergy Testing