Fluctuating olfactory sensitivity and distorted odor perception in allergic rhinitis

Objective: To characterize the relationship between allergic rhinitis, the severity and duration of nasal disease, olfactory function, and self-report ed olfactory symptoms, including fluctuations or distortions in odor percep tion. Design: Assessment of olfactory function and symptoms of 90 patients with a llergic rhinitis. Setting: A clinic of a university teaching hospital and research facility. Patients: Sixty patients who presented to the Taste and Smell Clinic who ha d positive allergy test results and 30 patients who presented to the Allerg y-Immunology Clinic. The Taste and Smell Clinic patients were grouped by na sal-sinus disease status (30 without chronic rhinosinusitis or nasal polyps , 14 with chronic rhinosinusitis but without polyps, and 16 with nasal poly ps). Main Outcome Measures: Subjective olfactory symptom questionnaire and objec tive olfactory function tests. Results: The Allergy-Immunology Clinic patients were diagnosed as being nor mosmic and the Taste and Smell clinic patients as being hyposmic or anosmic with olfactory loss that increased significantly with nasal-sinus disease severity. Comparisons with normative data confirm that olfactory scores obs erved in all groups were significantly lower than expected because of the a ging process alone. The self-reported duration of olfactory loss increased significantly with nasal-sinus disease severity. The Taste and Smell Clinic patients without chronic rhinosinusitis or nasal polyps reported the great est incidence of olfactory distortions and olfactory loss associated with u pper respiratory tract infections. Conclusions: There appears to be a continuum of duration and severity of ol factory loss in allergic rhinitis that parallels increasing severity of nas al-sinus disease, As a result of the increased frequency of respiratory inf ection associated with allergic rhinitis, these patients are at risk for da mage to the olfactory epithelium.