The diagnosis of allergic rhinitis: how to combine the medical history with the results of radioallergosorbent tests and skin prick tests.

OBJECTIVE

To identify the most useful combinations of symptoms and the results of radioallergosorbent tests (RASTs) and skin prick tests (SPTs) for the diagnosis of allergic rhinitis.

DESIGN

A prospective comparison was made of symptoms and the results of RASTs and SPTs with 7 different nasal allergies; the references used were the "consensus diagnoses" provided by 3 experts.

SETTING

Nineteen general practices in The Netherlands.

PATIENTS

365 consecutive patients aged 12 or over who visited their general practitioner because of chronic or recurrent nasal symptoms between 1 March 1990 and 1 March 1991.

MAIN OUTCOME MEASURES

The most useful combinations of items from the history, RASTs, and SPTs, for the diagnosis of 7 different nasal allergies; the predictive probabilities of these combinations.

RESULTS

Diagnostic criteria could be drawn up resulting in a near-perfect discrimination between patients diagnosed as having allergic rhinitis and patients diagnosed as not having allergic rhinitis. Most of these criteria combined only a single item from the history with either RAST or SPT. For nearly all nasal allergies, both the negative predictive probabilities and the positive predictive probabilities were 97% or more.

CONCLUSIONS

The common nasal allergies can be diagnosed with a very high certainty with the aid of simple diagnostic criteria. Data from a strictly limited case history combined with either RAST or SPT are sufficient.