Table 2

Components of a complete history and physical examination for suspected rhinitis [1]

History

Physical examination


Personal

• Nasal itch

• Rhinorrhea

• Sneezing

• Eye involvement

• Seasonality

• Triggers

Family

• Allergy

• Asthma

Environmental

• Pollens

• Animals

• Flooring/upholstery

• Mould

• Humidity

• Tobacco exposure

Medication/drug use

• Beta-blockers

• ASA

• NSAIDs

• ACE inhibitors

• Hormone therapy

• Recreational cocaine use

Quality of life

• Rhinitis-specific questionnaire

Comorbidities

• Asthma

• Mouth breathing

• Snoring

• Sinus involvement

• Otitis media

• Nasal polyps

• Conjunctivitis

Response to previous medications

• Second-generation oral antihistamines

• Intranasal corticosteroids

Outward signs

• Mouth breathing

• Rubbing the nose/transverse nasal crease

• Frequent sniffling and/or throat clearing

• Allergic shiners (dark circles under eyes)

Nose

• Mucosal swelling, bleeding

• Pale, thin secretions

• Polyps or other structural abnormalities

Ears

• Generally normal

• Pneumatic otoscopy to assess for Eustachian tube dysfunction

• Valsalva’s maneuver to assess for fluid behind the ear drum

Sinuses

• Palpation of sinuses for signs of tenderness

• Maxillary tooth sensitivity

Posterior oropharynx

• Postnasal drip

• Lymphoid hyperplasia (“cobblestoning”)

• Tonsillar hypertrophy

Chest and skin

• Atopic disease

• Wheezing


ASA: acetylsalicylic acid; NSAIDs: non-steroidal anti-inflammatory drugs; ACE: angiotensin-converting enzyme; OTC: over-the-counter

Adapted from Small et al., 2007 [1]

Small and Kim Allergy, Asthma & Clinical Immunology 2011 7(Suppl 1):S3   doi:10.1186/1710-1492-7-S1-S3

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