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The diagnosis of allergic rhinitis can generally be made on the basis of the history and physical examination. The history helps establish seasonality, potentially inciting factors, and co-morbidities including sinusitis, nasal polyps, allergic conjunctivitis, and asthma. On physical examination, the nasal mucous membranes are pale, wet, and boggy. Allergy testing is performed in order to confirm the diagnosis and which allergens are relevant to the symptoms.
The management of allergic rhinitis includes allergen avoidance, pharmacologic treatment, and specific immunotherapy. Mild symptoms are easily controlled with either a second-generation antihistamine or a nasal corticosteroid alone. For patients with moderate-to-severe symptoms with nasal congestion as a predominant finding, therapy should be started with daily use of a nasal corticosteroid, which would be combined with other medications, such as antihistamines and decongestants. Specific immunotherapy is generally reserved for the selected patients whose symptoms are inadequately controlled with a pharmacotherapy and allergen avoidance.
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