13 Differential Diagnosis
“Doc, I got the sinus”
Allergic rhinitis is a very common disorder and frequently patients will have their own euphemisms to describe the symptoms of allergies. While practicing in Mississippi, it was not unusual for a patient to tell the author that he/she had “the sinus,” not meaning a sinus infection, but actually referring to the sensation of sinus pressure, nasal congestion, and sneezing associated with an allergic flare-up. Allergies aren’t always to blame, though, and there are some equally common, nonallergic causes for nasal symptoms similar to those associated with allergic rhinitis.
13.1 The Mimics and Imposters
Here are some of the most common mimics of allergic rhinitis:
Viral rhinitis: Frequently confused with allergic rhinitis, viral rhinitis tends to last 4 to 6 days and is associated with the sneezing, clear nasal drainage, and nasal congestion that is typical of allergies. Fever can be helpful to distinguish this from allergies, but often may not occur, particularly in adults. Sore throat doesn’t help distinguish a viral infection from allergies.
Age-related (senile) rhinitis: The process of aging with its decline in autonomic function can lead to vasodilation and increased mucus consistency and quantity, resulting in nasal congestion and clear drainage that can appear similar to allergy. Complaints of clear nasal drainage actually increase with age, but true allergic rhinitis decreases as a person ages, due to changes in immune functions.
Nonallergic/vasomotor rhinitis: Inflammation is not a part of this type of rhinitis, which is the most common cause of nonallergic causes of rhinitis. This is a diagnosis of exclusion, tends to be more common in females than males, and the nasal mucosa look erythematous on physical examination.
Beware of the migraine patient. Patients with a history of migraines will frequently neglect to tell you about their migraines (or haven’t been properly diagnosed yet). Migraine sufferers can frequently develop a sinus pressure “headache” that may be accompanied by nasal congestion and runny nose, but it won’t respond very well to allergy medications. It generally will respond to migraine medications.
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