title: Diagnosing allergic rhinitis: effectiveness of the physical examination in comparison to conventional skin testing.
abstract: OBJECTIVE
  To evaluate the effectiveness of physical examination alone in diagnosing nasal allergic patients.
  
  
  METHODS
  A cross-sectional study of 15 consecutive evaluable patients.
  
  
  METHODS
  A tertiary care otolaryngology clinic at the Jewish General Hospital, McGill University, Montreal.
  
  
  METHODS
  All patients were assessed by three physicians in random order. Each conducted a specific examination, made a clinical impression, and then took a directed history to make a second impression. Both impressions were compared to skin testing. Multivariate regression analyses assessed the linear relationships of both examination and history variables to impressions and skin testing results. Fleiss kappa tests assessed interrater reliabilities.
  
  
  METHODS
  Accuracy in diagnosing allergic rhinitis by examination alone and inter-rater reliability in this diagnosis.
  
  
  RESULTS
  When comparing physical examination variables to history variables relative to the second impression, history variables had a stronger relationship (R²  =  .90 vs .52). This was also true when comparing both sets of variables to skin testing (R²  =  .81 vs .60). The interrater reliability of physical examination variables was poorer than that of the history variables (.377 and .494, respectively). Taking all physicians, the average sensitivity, specificity, positive predictive value, and negative predictive value of the history impression were all higher than those of the examination impression.
  
  
  CONCLUSIONS
  Physical examination alone yields unreliable and inconsistent results in diagnosing allergic rhinitis. This is likely secondary to the relative subjectivity involved in evaluating the nasal cavity. Adding a history to the examination is essential to increase diagnostic accuracy.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, QC.
authors.forename: S Naweed
authors.initials: SN
authors.lastname: Raza
authors.forename: Kashif
authors.initials: K
authors.lastname: Yousuf
authors.forename: Peter
authors.initials: P
authors.lastname: Small
authors.forename: Saul
authors.initials: S
authors.lastname: Frenkiel
mesh_terms: D000328:Adult; D000368:Aged; D000485:Allergens; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010808:Physical Examination; D012221:Rhinitis, Allergic, Perennial / Q000175:diagnosis*; D006255:Rhinitis, Allergic, Seasonal / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D012882:Skin Tests; D055815:Young Adult
chemical_list: D000485:Allergens