Allergic Rhinitis and Sinusitis: Diagnosis and Treatment

Diagnosis

• History and physical examination are the most important steps.
  
• The diagnosis may be confirmed by skin or blood allergy testing.
  
• The inner nose and sinuses can be visualized by use of a fiber optic rhinoscope.
  
• In cases of severe or recurrent sinusitis, a sinus CT scan may be recommended.

Treatment

Allergic Rhinitis

• Avoidance of inciting factors (e.g., pollen, mold, or dust mites) is the most helpful treatment.
  
• Avoidance of tobacco is beneficial.
  
• Nasal saline inhalers may improve symptoms.
  
• Among pharmaceutical treatments, nasal steroids are first–line agents. Other options include antihistamines (e.g., loratadine), ibuprofen, or oral decongestants (e.g., pseudoephedrine).
  
• Immunotherapy injections (“allergy shots”) may significantly improve symptoms and quality of life. However, these cannot be used in people who are taking beta–blockers.
  

Sinusitis

• Avoiding tobacco is beneficial.
  
• Nasal saline inhalers or nasal steroids may improve symptoms.
  
• Symptomatic treatment with antihistamines, decongestants, and nonsteroidal anti–inflammatory drugs (e.g., ibuprofen) may help to alleviate cough, congestion, and fatigue.

In presumed cases of bacterial sinusitis, antibiotics (e.g., amoxicillin) may be recommended. However, antibiotics are not useful for viral sinusitis. When antibiotics are used, a prolonged course (three to six weeks) may be necessary.