Small and Kim Allergy, Asthma & Clinical Immunology 2011, 7(Suppl 1):S3 http://www.aacijournal.com/content/7/S1/S3 Page 3 of 8 Intermittent Symptoms < 6 weeks Mild Normal sleep No impairment of daily activities, sport, leisure Normal work/school No bothersome symptoms Persistent Symptoms continue throughout the year Moderate-Severe Abnormal sleep, or Impairment of daily activities, sport, leisure, or Problems at work/school, or Bothersome symptoms Figure 1 Classification of allergic rhinitis according to symptom duration and severity. Adapted from Small et al., 2007 [1], Bousquet et al., 2008 [5] Table 2 Components of a complete history and physical examination for suspected rhinitis [1] History Personal Nasal itch Rhinorrhea Sneezing Eye involvement Seasonality Triggers Family Allergy Asthma Environmental Pollens Animals Flooring/upholstery Mould Humidity Tobacco exposure Medication/drug use Beta-blockers ASA NSAIDs ACE inhibitors Hormone therapy Recreational cocaine use Quality of life Rhinitis-specific questionnaire Comorbidities Asthma Mouth breathing Snoring Sinus involvement Otitis media Nasal polyps Conjunctivitis Response to previous medications Second-generation oral antihistamines Intranasal corticosteroids Physical examination Outward signs Mouth breathing Rubbing the nose/transverse nasal crease Frequent sniffling and/or throat clearing Allergic shiners (dark circles under eyes) Nose Mucosal swelling, bleeding Pale, thin secretions Polyps or other structural abnormalities Ears Generally normal Pneumatic otoscopy to assess for Eustachian tube dysfunction Valsalva’s maneuver to assess for fluid behind the ear drum Sinuses Palpation of sinuses for signs of tenderness Maxillary tooth sensitivity Posterior oropharynx Postnasal drip Lymphoid hyperplasia (“cobblestoning”) Tonsillar hypertrophy Chest and skin Atopic disease Wheezing ASA: acetylsalicylic acid; NSAIDs: non-steroidal anti-inflammatory drugs; ACE: angiotensin-converting enzyme; OTC: over-the-counter Adapted from Small et al., 2007 [1]