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Table 2 Components of a complete history and physical examination for suspected rhinitis [1]

From: Allergic rhinitis

History Physical examination
Personal
• Congestion
• Nasal itch
• Rhinorrhea
• Sneezing
• Eye involvement
• Seasonality
• Triggers
Family
• Allergy
• Asthma
Environmental
• Pollens
• Animals
• Flooring/upholstery
• Mould
• Humidity
• Tobacco exposure
Medication/drug use
• Beta-blockers
• ASA
• NSAIDs
• ACE inhibitors
• Hormone therapy
• Recreational cocaine use
Quality of life
• Rhinitis-specific questionnaire
Comorbidities
• Asthma
• Mouth breathing
• Snoring ± apnea
• Impaired smell or taste
• Sinus involvement
• Otitis media
• Nasal polyps
• Conjunctivitis
Response to previous interventions
• Avoidance measures
• Saline nasal rinses
• Second-generation oral antihistamines
• Intranasal corticosteroids
Outward signs
• Mouth breathing
• Rubbing the nose/transverse nasal crease
• Frequent sniffling and/or throat clearing
• Allergic shiners (dark circles under eyes)
Nose
• Mucosal swelling, bleeding
• Pale, thin secretions
• Polyps or other structural abnormalities
Ears
• Generally normal
• Pneumatic otoscopy to assess for Eustachian tube dysfunction
• Valsalva’s maneuver to assess for fluid behind the ear drum
Sinuses
• Palpation of sinuses for signs of tenderness
• Maxillary tooth sensitivity
Posterior oropharynx
• Postnasal drip
• Lymphoid hyperplasia (“cobblestoning”)
• Tonsillar hypertrophy
Chest and skin
• Atopic disease
• Wheezing
  1. Adapted from Small et al. [1]
  2. ASA acetylsalicylic acid, NSAIDs non-steroidal anti-inflammatory drugs, ACE angiotensin-converting enzyme