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Presentation and differential diagnosis of allergic rhinitis

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This is the first in a series of three articles which will discuss the presentation and treatment of allergic rhinitis. This piece will cover the presentation and differential diagnosis of allergic rhinitis and how to make a good diagnosis.

The second article will concentrate on therapeutic options in allergic rhinitis and the third article will look at the management of asthma and allergic rhinitis.

History and definition

Some clinicians believe the diagnosis and management of allergic rhinitis is unimportant and that it should be treated by patients or their family members with over-the-counter preparations.1

However, it is worth remembering that allergic rhinitis can have a significant impact on the quality of life and work of adults who suffer from it and can impact on children and adolescents, affecting sleep, education and activity.2,3,4

Indeed, Walker et al found children with allergic rhinitis were less likely to perform well in their GCSE exams than their peers.5 Scadding also found that, for 30 per cent of people with allergic rhinitis, their condition had a significant impact on their work, home or social life.1

This has been well known since the original description of hayfever by John Bostock in 1819 in his paper 'A Periodical Affection of the Eyes and Chest'. Bostock failed to highlight clearly the impact on the nose, concentrating on the eye, chest and systemic symptoms.6

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