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 t he results of radioallergosorbent tests (RASTs) and skin prick tests ( SPTs) for the diagnosis of allergic rhinitis. Design - A prospective c omparison was made of symptoms and the results of RASTs and SPTs with 7 different nasal allergies; the references used sere the ''consensus diagnoses'' provided by 3 experts. Setting - Nineteen general practice s in The Netherlands. Patients - 365 consecutive patients aged 12 or o ver who visited their general practitioner because of chronic or recur rent nasal symptoms between 1 March 1990 and 1 March 1991. Main outcom e measures - The most useful combinations of items from the history, R ASTs, and SPTs, for the diagnosis of 7 different nasal allergies; the predictive probabilities of these combinations. Results - Diagnostic c riteria could be drawn up resulting in a near-perfect discrimination b etween patients diagnosed as having allergic rhinitis and patients dia gnosed as not having allergic rhinitis. Most of these criteria combine d only a single item from the history with either EL-IST or SPT. For n early all nasal allergies, both the negative predictive probabilities and the positive predictive probabilities were 97% or more. Conclusion s-The common nasal allergies can be diagnosed with a very high certain ty with the aid of simple diagnostic criteria. Data from a strictly li mited ease history combined with either RAST or SPT are sufficient.