General Medical Information

Signs and Symptoms of Allergic Rhinitis

Richard L. Mabry

The existence of inhalant upper respiratory allergy is suggested by typical historical factors and physical signs and symptoms. Symptoms of inhalant allergy include itching of respiratory mucous membranes, sneezing, rhinorrhea, and postnasal drainage, which causes throat clearing and coughing. The symptoms may be seasonal or perennial, and a linkage with known exposure to allergens, especially dust and animal danders, often is noticed. Allergy symptoms can begin at any age, although children rarely have marked allergies to inhalants before 2 years of age. Symptoms among younger children often are caused by food hypersensitivity.

Signs of allergic rhinitis can be accompanied by allergy signs noticed during a head and neck examination. Patients with airway obstruction from nasal allergy often have an open-mouthed adenoid facies. Itching membranes cause involuntary grimacing, accompanied by repetitive upward wiping of the tip of the nose with the hand (allergic salute). This mannerisms ultimately produces a visible transverse crease across the tip of the nose. Infraorbital tissue congestion manifests as so-called allergic shiners and puffiness around the eyes. Allergic nasal mucosa appears pale during rhinoscopy, with clear rhinorrhea in the absence of secondary infection. Polyps may be present, and although not all polyps are allergic in origin, patients who have nasal polyps should be evaluated for contributory allergy. In addition to a high-arched palate, which is part of the nonadenoidal adenoid facies, prominent pharyngeal lymphoid follicles and lateral bands are common among patients with allergies.