Examinations of Allergic Rhinitis
Medical History and Physical Examination
Personal history and family history Understand the patient's work and living environment, occupation, whether there is a history of allergies to pollen, food, etc., and whether there are people in the family who suffer from allergic diseases.
Subjective Symptoms
If the patient has typical symptoms of allergic rhinitis such as paroxysmal sneezing, clear watery nasal discharge, nasal itching, nasal congestion, and eye symptoms such as itchy eyes, red eyes, and tears (indicating a high possibility of pollen allergy).
Physical Examination
Check whether the patient has symptoms such as swollen eyelids, conjunctival congestion, dark red, light blue, or pale nasal mucosa, edema, enlarged nasal conchae, small nasal polyps, and watery or mucous secretions in the nasal cavity; auscultate the lungs to see if there is wheezing (if there is, it indicates that there may be asthma)
Nose Examination
Anterior nasal endoscope and nasal endoscope are the most widely used examination methods, which can be confirmed through this examination.
The anatomy of the nose, including whether the nasal septum and inferior turbinate are enlarged, whether there are polyps in the nasal passages, etc.: Whether the nasal mucosa is edematous, whether the color is normal, whether there are symptoms such as dark red, light blue or pale, Whether there are watery or mucous secretions in the nasal cavity and the amount of secretions.
Allergen Skin Test
Allergen skin test is an important method for testing allergens and diagnosing allergic diseases. It conducts diagnosis by observing the skin reaction after the allergen comes into contact with the skin. Specific method: Stimulate the skin with various common allergen extracts. If the patient is allergic to a certain allergen, wheals and redness will appear at the site of stimulation, which is considered positive. The degree of positivity (+, ++, +++) is determined according to the size of the wheal.
Skin tests include allergen intradermal test, skin prick test (SPT), scratch test, patch test, etc. The former two are the most widely used. It should be noted that the results of skin tests are easily affected by certain drugs, especially antihistamines; the age of the patient and the difference in the test site will also interfere with the results; if the patient has a skin disease, it’s difficult to perform skin tests.
Intradermal Skin Test
The test results are poorly correlated with symptoms and may cause some false positive reactions and systemic reactions, so it is not widely used.
Skin Prick Test (SPT)
It is widely used and can be used to detect a variety of inhaled antigens, including dust mites (house dust mites and dust mites), seasonal grass pollens (giant ragweed, mugwort, sheep horns, humus, Chenopodium album), animal hair (dogs and cats), fungi (indoor and outdoor flowers or flower environments) and cockroaches.
Specific IgE Test
Serum specific IgE determination: It is necessary to draw blood from patients and detect free specific IgE in serum. If the serum specific IgE of patients with allergic rhinitis is positive and equal to or higher than level 2, and the patient's medical history shows that exposure to the allergen corresponding to the positive IgE can induce symptoms, allergic rhinitis can be diagnosed.
Nasal Provocation Tests (NPTs)
The allergen is exposed to the nasal mucosa to observe whether clinically relevant symptoms are induced and the patency of the nasal cavity is evaluated. The specific test method is to stick a filter paper with allergen solution (stimulant) adsorbed on the inferior turbinate, or use a metering pump to spray the stimulant into the nasal cavity, and gradually increase the allergen concentration until a positive reaction occurs. The lower the allergen concentration, the greater the responsiveness of the nasal mucosa, that is, the higher the sensitivity to the allergen.
Record the symptoms after the stimulation test, and make a comprehensive evaluation based on the objective examination results (the amount of nasal secretions, changes in nasal resistance or airflow, etc.)
Other Examinations
During the attack period, a smear of nasal secretions can be seen, and more eosinophils can be seen; A nasal mucosal scraping examination can show mast cells or basophils.