Rhinitis classification & management

Screens for red flags, confirms the allergic phenotype by specific IgE, separates drug-induced and nonallergic causes, and sequences intranasal therapy and immunotherapy (2020 Rhinitis Practice Parameter).

Evidence tier: Guideline-derived.

Decision points

  • Any red flags?
  • Likely category?

Do-not-miss pitfalls

  • Do not label rhinitis "allergic" on history alone, confirm clinically relevant specific IgE.
  • Do not order routine food panels for rhinitis.
  • Do not miss medication-induced rhinitis (decongestant/cocaine rebound, ACEi, beta-blockers, NSAIDs, estrogens, PDE-5, etc.).
  • Do not use INCS + ORAL antihistamine as initial combination therapy, the intranasal antihistamine is the one that adds benefit.
  • Do not ignore unilateral or red-flag symptoms as sentinels of structural disease.

Evidence & citations

  1. Dykewicz MS, Wallace DV, Amrol DJ, et al. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol. 2020;146(4):721-767. PMID 32707227
  2. Wise SK, Damask C, Roland LT, et al. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis, 2023 (ICAR:AR-2023). ICAR-AR 2023

Clinician decision support. Verify against the cited source. Not a substitute for clinical judgment. 100% on-device; no patient data is stored or transmitted.