A physician may be tempted to overlook the physical examination of an allergic patient, but it’s an important part of your workup. Yes, it is true that frequently the physical examination can be completely normal. However, that’s no reason to skip this part or do a cursory examination. While it is helpful to discover findings suggestive of allergy, one of the main reasons to do a thorough physical examination is to discover those findings that suggest it’s not allergy (or at least, not only allergy). It’s disheartening to both patient and provider when the patient, who has undergone immunotherapy for an extended period of time, perceives little to no benefit, because he/she is suffering from another medical condition (chronic sinusitis, nasal polyposis, etc.). The physical examination isn’t necessarily important because it helps you diagnose allergic disease, but because it helps you diagnose or eliminate other disorders.
12.2 The Physical
What are you looking for? ▶Table 12.1 provides a general guide and includes physical examination findings that are suggestive if the patient is suffering from allergic disease or not. It is not exhaustive, encompassing, or absolute (▶Fig. 12.1, ▶Fig. 12.2, ▶Fig. 12.3, ▶Fig. 12.4).
Fig. 12.1 Left eye with “allergic shiner” underneath lower eyelid.Fig. 12.2 Right enlarged inferior turbinate. Bluish discoloration of mucosa is typical of that seen with allergic rhinitis.Fig. 12.3 Left enlarged inferior turbinate. Note the mixed erythematous and bluish mucosa. The erythema shown here is more typical of nonallergic rhinitis and a mixed rhinitis is pictured here.Fig. 12.4 Endoscopic view of right posterior nasopharynx. Note the enlarged adenoids and clear nasal drainage flowing over the right eustachian tube. This is typical of allergic rhinitis.
Clinical Pearls
The physical examination is important.
Pay close attention to findings that indicate associated comorbid diseases other than allergy.
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