Rhinitis
Intermittent acute rhinitis must be distinguished from chronic rhinitis, which has a wider differential diagnosis. The definitions of acute and persistent rhinitis are variably defined; one group defined persistent rhinitis as occurring at least 4 days a week for at least 4 weeks;13 another group holds that acute rhinitis may last as long as 12 weeks.14 The evidence base on the timing and nature of appropriate investigations in persistent rhinitis is scanty; however, recent combined adult and pediatric guidelines have listed potential investigations that may be useful.14 The two common causes are infective and allergic rhinitis, and skin prick testing may be indicated. Unilateral rhinitis should lead to consideration of anatomic abnormalities such as unilateral choanal stenosis or the presence of a foreign body. The combination of persistent rhinitis and lower respiratory tract symptoms should prompt diagnostic consideration of allergic rhinitis and asthma (the most common cause); primary ciliary dyskinesia (PCD), especially with neonatal onset of rhinitis; CF (especially if there are nasal polyps); and Wegener's granulomatosis (seen in 21 of 25 patients in one series).15
Recommendations
Persistent rhinitis usually does not require detailed investigations. Evidence of allergic sensitization may be sought, and empiric therapeutic trials are reasonable, unless there is evidence that rhinitis is part of a more generalized disease. Level of evidence: low.
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