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Table 2 Diagnosis of multi-morbidities associated with allergic rhinitis (AR)

From: Multi-morbidities of allergic rhinitis in adults: European Academy of Allergy and Clinical Immunology Task Force Report

Multi-morbidities of AR Definitive medical history, symptoms and signs
Asthma Ask about any history of cough, wheeze, shortness of breath, exercise-induced bronchospasm
Examine the chest for wheeze, hyperexpansion
Assess peak expiratory flows and spirometry in older children preferably with reversibility testing with beta-2 agonists
If in doubt, undertake an exercise, mannitol or methacholine challenge test or measure exhaled nitric oxide (FENO)
Conjunctivitis Ask about a history of red, itchy, watery eyes, eye rubbing
Examine eyes
Rhinosinusitis Ask about a history of nasal obstruction or discharge (purulent) with or without hyposmia, headache, facial pain or cough
Undertake nasendoscopy in older children
CT scan/sinus X-rays not recommended unless there are complications or failed therapy, unilateral symptoms or severe disease unresponsive to medical therapy
Otitis media with effusion (OME)/impaired hearing Ask questions related to immune deficiency and/or recurrent infections
Ask about any speech and language delay, increasing volume of TV, shouting, poor concentration, failing performance at school, frustration, irritability
Examine the ears using a pneumatic otoscope if possible, and Weber and Rinne tests
Use tympanoscopy for evaluation of tympanic membrane and middle ear
Undertake tympanometry
Use a whisper test to screen otitis media with effusion and hearing loss
Use audiometry in older children—pure tones, speech
Obstructive sleep apnea and sleep problems Enquire about any history of disturbed sleep, snoring, apnoea, tiredness, irritability
Assess nasal airway using spatula misting, nasal inspiratory peak flow, visual examination of nostrils and nasendoscopy in older children to view nasal airway and adenoids
Consider sleep study
Atopic dermatitis Ask about skin symptoms of itching, redness, rash
Food allergy Ask about symptoms related to food intake
Ask for oral allergy syndrome (OAS): Allergic reaction that occurs upon contact of the mouth and throat with raw fruits or vegetables which may be tolerated when cooked
Eosinophilic oesophagitis Ask for symptoms related to esophageal dysfunction as solid food dysphagia, chest pain, heartburn and upper abdominal pain
Assess esophageal biopsies
Adenoid hypertrophy Ask about nasal obstruction, open mouth breathing and snoring
Examine the face
Perform posterior rhinoscopy; nasal and nasopharyngeal rigid/flexible endoscopy
Olfactory dysfunction Ask for olfactory dysfunction, hyposmia, anosmia
Evaluate nasal airway and smell function tests
Laryngitis, cough and vocal problems Ask for symptoms including irritation in the throat, the sensation of difficult to shift mucus and cough
Examine throat and larynx, see vocal cords and arytenoids
Gastro esophageal reflux Ask for symptoms of indigestion, regurgitation, cough
Examine throat and larynx
Fatigue and learning impairment Ask about fatigue and learning impairment, school success
Ask about sleep quality, nasal obstruction and nasal discharge
Turbinate hypertrophy Ask about nasal obstruction
Perform anterior rhinoscopy and nasal endoscopy, acoustic rhinometry pre and post decongestant shows whether mucosal lining or bony structure is responsible