Allergy diagnosis: What to look for in history and physical examination?

Abstract

With 20% of the world population living in India, asthma and allergic disorders have emerged as a significant cause of mortality and morbidity. Most of the cases are managed by primary care physicians who have to rely greatly on history and physical examination in the absence of effective diagnostic tools. The following is a review article on the essentials of history and physical examination for allergic disorders. The main aim of the history obtained from the parent/caregiver is to help us in diagnosing true allergic disorders from the close differentials. History is essentially divided into four parts – description of symptoms in detail, presence of comorbid conditions, finding out the sensitizers or irritants, and a systematic analysis of past, family, treatment, occupational, sports, and leisure activities, the impact of the disease on the family. The history also helps in finding out red flags that point to a differential diagnosis. The physical examination allows us to evaluate the chronic impact of the disease on the child, including anthropometry, upper and lower respiratory tracts, as well as pointers for comorbid conditions like allergic rhinosinusitis with or without adenotonsillar hypertrophy, conjunctivitis, with allergic skin conditions such as urticarial and atopic dermatitis. Even in the era of increase in the diagnostic armamentarium of investigations, a good history and physical examination help us in establishing the diagnosis, finding the differentials, grading the severity, finding out the sensitizers, and assessing the comorbid condition and impact of the disease on the family.