Home > Health Topics > Allergic Rhinitis
 Definition | Causes | Symptoms | Diagnosis | Treatment | Prevention | References
   
Allergic Rhinitis : Diagnosis
   
Western Medicine Chinese Medicine

The diagnosis of allergic rhinitis is established by the history and physical findings present during the symptomatic phase. Although the sneezing attacks, nasal discharge or blockage are characteristic, they are not unique to this disorder, and the symptoms of perennial rhinitis are similar to those of other conditions. The distinctive feature of allergic rhinitis is that compatible symptoms appear or worsen predictably in response to specific allergen exposures. (That is, a person develops a runny nose or sneezing whenever he/she is exposed to pollen etc.) Therefore, in diagnosis, careful analysis of factors precipitating rhinitis is of overriding importance.

Many persons with nonallergic "vasomotor" rhinitis have similar nasal stuffiness and marked nasal discharge. This group does not respond to identifiable allergens. Instead, their complaints relate largely to airborne irritants, extremes of temperature and humidity, pregnancy, stages of the menstrual cycle, and emotional factors. Here, stimulation of vasomotor control causes a change in the diameter of the blood vessels supplying the nose.

Clinical history
A clinical history of symptoms on exposure provides the clearest indication of causative agents in respiratory allergy.

Variations in symptoms during and after travel can be very significant.
The effects of overt exposure to house dust mites, animals and fur products, feathers, seed derivatives, silk, and so forth should be noted and recorded.
When such casual observations are insufficient, history may be "created" by markedly increasing and/or reducing specific exposures, such as foods or house pets, for brief periods to observe the results.
In addition, the time or place of symptom occurrence may furnish clues as to a cause that is not immediately evident. Specific pollen sensitivities may be deduced if the resulting symptoms can be dated precisely and "season" of prevalence for local airborne pollens are known. Similarly, recognition of the heavy fungus exposures associated with leaf collection, lawn care, and gardening as well as with hiking in tall vegetation helps to explain associated symptoms.

Skin testing
Skin tests eliciting a wheal-and-flare reaction can be useful and are widely performed. To test immediate reactivity to an allergen, a "prick test" is performed by pricking the skin through applied drops of a water-extract of a particular allergen. Small quantities of extracts can also be injected through the skin using a needle, but as this procedure may be hazardous in exquisitely sensitive persons, prick tests are usually done first. Only persons with negative reactions to the prick test are considered for the injection test. Few additional test procedures help evaluate respiratory allergy. Initial hopes that a blood test might help diagnosis have not been sustained.

 

 
 

Based on the four examination technique, TCM practitioners make a diagnosis according to clinical symptoms and further characterize the disorder by the disharmony patterns displayed by each individual. At various stages of disease, different disharmony patterns are present and individuals with the same disease will be treated differently depending on the type of disharmony pattern they have.

In allergic rhinitis, the procedures used in TCM to differentiate between disharmony patterns can be explained as follows:

1. Deficiency of lung qi, invasion by wind and coldness evils
  Due to a constitutional weakness, the individual is susceptible to influenza or other illnesses. In terms of TCM, this usually means that the individual does not have strong protective qi and this enables the wind evil and coldness evils to invade the nose easily. On examination, the nasal mucosa is pale and swollen, with a slight watery discharge. The tongue is pale and covered by white fur. The pulse is weak and feeble.
2. Lung and spleen deficiency, dampness accumulation in the nose
  When the lungs and spleen are deficient or under-functioning, an imbalance of body-fluid metabolism and dampness evil ccumulation results. Dampness evils flow through the meridians and accumulate in the nose to produce a swollen, pale nasal mucosa and excessive secretions. On examination, the nasal mucosa is clearly swollen and polyps (small growths) or similar changes may be seen. The tongue appears bulky, pink and furrowed, and is covered by white greasy fur. The pulse is weak and hesitant.
3. Depletion in kidney yang, lungs lose promoting and warmth support from the kidneys
  In TCM, the kidney yang is considered to be the fundamental source of promotion and provision of warmth to the body. Depletion of kidney yang usually occurs after long-term or severe damage of organs. It leads to under-functioning of the organs, interrupted flow of qi and blood, and also affects the functioning of the lung and the nose. On examination, the tongue is pink and covered with moist white fur. The pulse is weak and thready.
4. Spleen deficiency, stagnation of phlegm evil
  TCM practitioners believe that the spleen and stomach are very vulnerable to an improper diet, invasion by exogenous evils, or the effects of other organ deficiencies. A deficiency or under-functioning of the spleen leads to a decline in qi and blood or acquired essence (jing) production. The consequence of this is that the body is malnourished and phlegm evil will accumulate. The effect on the nose is to cause it to lose its supply of nutrients and for the nasal mucosa to develop related syndromes. On examination, the tongue is pale and covered by white greasy fur. The pulse is slippery.
5. Invasion of wind and heat evils in the lungs
  When exogenous evils, like wind and heat, attack the protective qi, a nasal disorder usually presents as part of the lung-wei syndrome. On examination, the nasal mucosa is swollen, there is congestion, and some watery discharge, or the discharge may be slightly sticky and thick. The tongue is red and covered with thin fur that may be yellow. The pulse is floating and rapid.