rhinitis
Enable an AI agent to recognise a rhinitis presentation, record its suspected causes and current burden, and support evidence-based assessment, management and reassessment.
Research draft, second pass
A second pass drafted this model: the structure a model of this thing needs, and what is known about it in the world. The line under this one says how the second half was obtained - researched against sources, or recalled without web access, in which case nothing here was read anywhere and every claim is a lead to verify. Unreviewed either way.
Researched by: Codex + Grok
Purpose and description
Enable an AI agent to recognise a rhinitis presentation, record its suspected causes and current burden, and support evidence-based assessment, management and reassessment.
Rhinitis is inflammatory or hyperreactive disease of the nasal mucosa that produces two or more of nasal obstruction, anterior or posterior rhinorrhea, sneezing, and nasal itching, with or without ocular symptoms, and is grouped by mechanism (IgE-mediated allergic, infectious, or non-allergic) rather than by a single pathognomonic lesion.
It can be Build a dated rhinitis profile that separates observations, patient reports and clinical interpretations; Compare causal hypotheses against symptom timing, exposures and diagnostic evidence; Identify missing information needed before selecting a rhinitis management pathway; Track symptom and functional changes during exposure modifications or clinician-directed treatment; Flag atypical presentations and linked airway conditions for appropriate clinical assessment; Prepare a review summary explaining persistent symptoms, treatment limitations and unresolved causes.
Distinguishing features
Require a compatible nasal symptom pattern and history; a runny nose alone does not establish a rhinitis subtype. Allergic attribution requires evidence consistent with an allergic cause. [AAO-HNSF guideline summary](https://www.entnet.org/resource/aao-hnsf-cpg-allergic-rhinitis-press-release-fact-sheet/)
Distinguish symptomatic allergy from sensitisation by recording whether a tested allergen matches actual exposure and symptom timing. [AAO-HNSF guideline summary](https://www.entnet.org/resource/aao-hnsf-cpg-allergic-rhinitis-press-release-fact-sheet/)
Test whether symptoms track irritants, temperature changes, food, hormonal changes or medicines when evaluating non-allergic explanations. [NHS non-allergic rhinitis](https://www.nhs.uk/conditions/non-allergic-rhinitis/)
Record evidence for accompanying sinus disease rather than treating nasal discharge or obstruction as sufficient to identify rhinosinusitis.
Separate fluctuating nasal symptoms from persistent unilateral obstruction, bleeding or atypical watery discharge that requires assessment for an alternative cause.
Scope
+ Nasal obstruction, rhinorrhoea, sneezing and itching, including timing, laterality and examination findings
+ Allergic, infectious, non-allergic, mixed and unresolved causal interpretations
+ Exposure relationships, including allergens, irritants, work environments and medicines
+ Episode duration, recurrence, symptom burden and effects on sleep and daily activities
+ Evidence supporting diagnosis, treatment selection, response assessment and referral
- Full diagnosis and management of rhinosinusitis and nasal polyposis
- Structural nasal disorders, foreign bodies, tumours and cerebrospinal fluid leaks
- Asthma, conjunctivitis and other associated conditions beyond their relationship to rhinitis
- Whole respiratory infections, pathogen biology and transmission management
- Drug monographs, prescribing systems and detailed immunotherapy protocols
Characteristics
- Nasal symptom profile
- Obstruction, anterior or posterior rhinorrhoea, sneezing, itching; each present, absent or unknown Establishes the presentation and identifies which symptoms require explanation or relief.
- Symptom intensity
- Named symptom scale, recorded range, recall period and assessment date Enables interpretable comparisons without combining incompatible scores.
- Temporal pattern
- Onset date, duration in days or weeks, symptomatic days per week and symptom-free intervals Distinguishes episodes, persistence and recurrence without assuming that seasonal symptoms are brief.
- Laterality
- Bilateral, alternating, persistent left, persistent right or unknown Helps identify presentations needing structural or other differential assessment.
- Causal interpretation
- Allergic, infectious, non-allergic, mixed or unresolved; multiple hypotheses permitted Prevents all rhinitis from being treated as hay fever.
- Diagnostic certainty
- Suspected, supported, clinician-established, disputed or unresolved, with evidence and date Separates observed symptoms from interpretations.
- Trigger relationship
- Exposure linked to onset, worsening or improvement; latency, reproducibility and evidence Supports targeted exposure assessment and avoids assuming causality from coexistence.
- Allergen sensitisation evidence
- Allergen, test method, result, laboratory units or interpretation, date and clinical concordance Preserves the distinction between a test result and a clinically relevant trigger.
- Functional burden
- Sleep disruption, affected activity days and named quality-of-life score with recall period Captures consequences that symptom counts alone may miss.
- Current control
- Controlled, partly controlled, uncontrolled or unassessed under a named assessment rule Supports reassessment while keeping control distinct from underlying severity.
- Intervention response
- Intervention linked to symptom change, adverse effects, adherence, technique and observation interval Distinguishes an ineffective treatment from an inadequately implemented trial.
Also called
Where this came from
wikidata · CC0 1.0
Drafted structure
Bundle to layer to finding to question, as the second pass will find it: 6 bundles · 11 layers · 18 findings · 29 questions.
Nasal presentation Record the nasal manifestations that make rhinitis a plausible interpretation.
An agent needs a recognisable presentation before assigning a cause or judging treatment response.
Symptom pattern
Describe the symptoms in the person's own terms and as clinically interpreted.
Core nasal manifestations
Record obstruction, discharge, sneezing and itching individually, including the dominant complaint.
- Which nasal symptoms are present, absent or unassessed, and which is most troublesome? definition
- How were symptom intensity, discharge characteristics and laterality observed or reported? measurement
Examination and attribution
Connect the reported presentation with dated examination evidence.
Nasal assessment evidence
Preserve mucosal, turbinate and discharge observations separately from the diagnosis inferred from them.
- Who assessed the nasal cavity, when, by what method, and what was observed? provenance
- Which observations support rhinitis, and which require an additional or alternative explanation? boundary
Causes and triggers Represent competing or coexisting explanations for the nasal symptoms.
Rhinitis management depends on the supported mechanism and exposure relationship rather than the label alone.
Allergic attribution
Relate suspected allergens to exposure history and relevant investigations.
Allergen symptom concordance
Record sensitisation results separately from evidence that the allergen causes this person's symptoms.
- Which exposures precede symptoms reproducibly, and do symptoms change when the exposure ends? measurement
- What skin or specific-IgE testing was performed, and how does its interpretation fit the exposure history? provenance
Other and mixed attributions
Capture infectious, irritant, occupational, medication-related and other non-allergic hypotheses.
Non-allergic contributors
Record candidate contributors and their evidence without forcing a single exclusive subtype.
- How do symptoms relate to respiratory illness, workplace attendance, irritants, weather, meals, hormonal context or medicine use? measurement
- What supports each contributor, and could allergic and non-allergic mechanisms coexist? boundary
Course and burden Describe how rhinitis evolves and how much it disrupts the person's life.
Frequency, intensity and functional impact inform different aspects of assessment and must remain distinguishable.
Episode and recurrence
Represent onset, persistence, symptom-free intervals and exposure-linked recurrence.
Temporal classification
Retain raw timing observations alongside any classification and its stated rule.
- When did symptoms begin, how many days per week occur, and how long are symptom-free intervals? measurement
- Which definition supports any acute, chronic, intermittent, persistent or seasonal label, and does it apply to the suspected subtype? definition
Impact and control
Assess symptom burden and impairment under the current management conditions.
Rhinitis functional impact
Record sleep, work, school and activity effects alongside the person's treatment goals.
- Over what recall period did nasal symptoms disrupt sleep, concentration, work, school or usual activities? measurement
- What symptom or activity outcome would count as acceptable control for this person? action
Diagnostic boundaries and escalation Identify presentations that need another model or additional clinical assessment.
A rhinitis label must not absorb structural disease, sinus disease or important associated airway problems.
Alternative nasal causes
Assess atypical features and evidence for overlapping or alternative nasal disorders.
Atypical presentation review
Preserve unilateral symptoms, bleeding, pain, smell change and unusual watery discharge as explicit assessment inputs.
- Are persistent unilateral obstruction, bleeding, marked pain or unusual watery discharge present, including any relevant trauma or surgery history? boundary
- What assessment or referral is indicated by the specific findings under the applicable clinical pathway? action
Associated airway and eye conditions
Link associated conditions while preserving their separate assessment and management.
Associated condition status
Record whether asthma, conjunctivitis, sleep-disordered breathing or rhinosinusitis is suspected or established. [AAO-HNSF guideline summary](https://www.entnet.org/resource/aao-hnsf-cpg-allergic-rhinitis-press-release-fact-sheet/)
- Which associated conditions are reported, suspected or diagnosed, and what evidence supports those states? provenance
- Which symptoms or management needs belong to the associated condition rather than rhinitis? boundary
Management and reassessment Connect management choices to the supported cause, patient context and observed outcomes.
An agent must be able to explain why an action is appropriate and what evidence would justify continuing or changing it.
Management fit
Record the rationale and prerequisites for exposure measures, medicines or specialist assessment.
Rhinitis action selection
Tie each proposed intervention to a target symptom or contributor and to applicable clinical guidance.
- Which supported contributor or troublesome symptom is the proposed intervention intended to address? action
- What age, pregnancy, comorbidity, concurrent medicine or patient-preference factors affect its suitability? boundary
- Which guideline or clinician decision supports the action, and what evidence is still needed before proceeding? provenance
Response and revision
Interpret outcomes in light of actual use, delivery technique and changing exposures.
Adequate trial and next step
Assess benefit, adverse effects and implementation before treating persistent symptoms as treatment failure; record possible decongestant-related worsening. [NHS non-allergic rhinitis](https://www.nhs.uk/conditions/non-allergic-rhinitis/)
- What changed after treatment, over what interval, and with what adherence, nasal delivery technique and exposure changes? measurement
- Does the evidence support continuing, correcting use, reviewing medication-related worsening, reconsidering the cause or obtaining specialist assessment? action
Evidence and external alignment What the world already says about this thing, gathered so the model can be checked against it.
A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.
Reported evidence
Findings from the breadth pass, kept separate from the structural claims.
Kinds and varieties
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Allergic rhinitis (IgE-mediated; intermittent/seasonal or persistent/perennial; also local allergic rhinitis with nasal but not systemic IgE)
- Infectious rhinitis (almost always viral acute; bacterial superinfection uncommon as a primary nasal picture)
- Idiopathic / vasomotor non-allergic rhinitis (triggers such as cold air, odours, humidity, without IgE sensitisation)
- Mixed rhinitis (clinically important overlap of allergic and non-allergic mechanisms in the same patient)
- Occupational rhinitis (allergic or irritant, temporally related to workplace exposures)
- Drug-induced rhinitis, including rhinitis medicamentosa from topical α-agonist overuse
- Hormonal rhinitis (pregnancy rhinitis; less often hypothyroidism or other endocrine change)
- NARES (non-allergic rhinitis with eosinophilia) and atrophic rhinitis (including ozaena), which are treated as distinct non-allergic phenotypes
- Which of these kinds and varieties hold for the sense of rhinitis this model covers, and on what evidence? provenance
Identifiers and schemes
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Wikidata - Q114085 - Item for rhinitis as a disease; allergic rhinitis is a separate item (commonly Q190815).
- ICD-11 MMS - CA08 (Rhinitis); CA08.0 Allergic rhinitis; CA08.1 Non-allergic rhinitis - WHO statistical classification; acute common cold is coded elsewhere (CA00).
- ICD-10 - J30 (vasomotor and allergic rhinitis, with J30.0-J30.4 children); J31.0 Chronic rhinitis - Still the billing code set in many jurisdictions; acute infectious rhinitis is often J00.
- SNOMED CT - 70076002 |Rhinitis (disorder)| - Clinical terminology; allergic, vasomotor and other subtypes have their own concept IDs under this parent.
- MeSH - D012220 - Rhinitis; Hay Fever / allergic rhinitis is D006255.
- UMLS CUI - C0035455 - Maps the MeSH/SNOMED rhinitis cluster.
- Which of these identifiers and schemes hold for the sense of rhinitis this model covers, and on what evidence? provenance
Standards and regulation
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- ARIA (Allergic Rhinitis and its Impact on Asthma) - WHO-associated international guideline, successive revisions in Allergy / JACI; the usual global clinical standard for classification and stepped care.
- AAAAI/ACAAI Rhinitis practice parameters (Rhinitis 2020 and predecessors) - Joint Task Force on Practice Parameters, United States.
- BSACI rhinitis guideline (2017 revision) - British Society for Allergy and Clinical Immunology.
- EAACI position papers on allergic rhinitis, occupational rhinitis, and allergen immunotherapy - European Academy of Allergy and Clinical Immunology.
- ICD-10 / ICD-11 - World Health Organization (statistical coding; many national modifications, e.g. ICD-10-CM in the US).
- EPOS 2020 - European Rhinologic Society position paper, used to keep rhinitis distinct from chronic rhinosinusitis in ENT practice.
- Allergen immunotherapy is additionally governed by national medicines regulators (FDA, EMA and counterparts) as a biological product, not by a rhinitis-specific statute.
- Which of these standards and regulation hold for the sense of rhinitis this model covers, and on what evidence? provenance
Real-world use
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- One of the commonest reasons for primary-care visits and for pharmacy purchase of oral antihistamines, intranasal corticosteroids, saline rinses, and topical decongestants.
- Work-up in allergy/immunology clinics with skin-prick testing or serum specific IgE, then allergen avoidance, pharmacotherapy, or subcutaneous/sublingual immunotherapy.
- Occupational health case-finding in bakers, laboratory-animal workers, farmers, and chemical/isocyanate settings, sometimes with workplace peak-flow or nasal challenge.
- ENT examination when symptoms are unilateral, persistent, or suggestive of polyps, foreign body, or cerebrospinal-fluid leak rather than ordinary rhinitis.
- Public-health and media use of pollen calendars and daily pollen/spore counts to explain seasonal peaks (grass and birch in much of Europe; ragweed in North America; Japanese cedar in Japan).
- Treated as a treatable driver of poor sleep, presenteeism, exam performance, and of coexisting asthma control rather than as a trivial nuisance.
- Which of these real-world use hold for the sense of rhinitis this model covers, and on what evidence? provenance
Typical measurements
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Total Nasal Symptom Score (TNSS): congestion + rhinorrhea + sneezing + itching, each 0-3 - 0-12; trial entry often ≥6-8 - score
- Nasal symptom visual analogue scale (ARIA) - 0-10; <5 often treated as mild, ≥5 as moderate-severe - cm
- Peak nasal inspiratory flow (PNIF) - roughly 80-200 in unobstructed adults; values below about 70-80 suggest obstruction (age- and sex-dependent) - L/min
- Serum specific IgE (ImmunoCAP-type assays) - negative cutoff commonly <0.35; sensitised patients from 0.35 to >100 - kUA/L
- Skin-prick test wheal (mean diameter vs saline control) - positive usually ≥3 mm greater than negative control - mm
- Nasal-smear eosinophils (NARES phenotype) - often quoted as >20% of recovered leukocytes, cut-offs vary by lab - %
- Which of these typical measurements hold for the sense of rhinitis this model covers, and on what evidence? provenance
Failure modes and hazards
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Rhinitis medicamentosa: rebound congestion after more than a few days of topical α-adrenergic decongestants.
- Undertreated allergic rhinitis is a recognised co-factor for incident asthma and for poor asthma control (the ARIA rationale).
- Sleep fragmentation, snoring, daytime somnolence, and reduced school or work performance from nocturnal obstruction and post-nasal drip.
- First-generation oral antihistamines: sedation, anticholinergic effects, falls risk in older adults; topical decongestants and some oral decongestants: hypertension, palpitations.
- Allergen immunotherapy can cause systemic allergic reaction including anaphylaxis (a treatment hazard, not a property of untreated rhinitis).
- Chronic untreated inflammation may coexist with or progress toward chronic rhinosinusitis and nasal polyposis; the causal boundary is not fully settled.
- Missed serious mimics (CSF leak, tumour, foreign body) if unilateral watery or foul discharge is labelled ordinary rhinitis.
- Which of these failure modes and hazards hold for the sense of rhinitis this model covers, and on what evidence? provenance
Regional variation
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Everyday name: 'hay fever' remains common in the UK, Ireland, Australia and New Zealand; US lay speech more often says 'allergies' or 'seasonal allergies'.
- Classification language: ARIA intermittent/persistent is the international guideline pair; many US clinicians still use seasonal vs perennial.
- Dominant aeroallergens differ: grass and birch in much of Europe; ragweed (Ambrosia) in large parts of North America; Cryptomeria japonica (sugi) pollinosis is the emblematic seasonal rhinitis in Japan; house-dust mite dominates perennial disease in humid temperate and tropical belts.
- ICD billing: ICD-10-CM J30.x in the United States versus ICD-10/ICD-11 national modifications elsewhere; some systems still dump chronic cases into J31.0.
- Over-the-counter corticosteroid nasal sprays have been widely available for years in some countries (e.g. UK, US) and remain more restricted in others.
- Which of these regional variation hold for the sense of rhinitis this model covers, and on what evidence? provenance
Neighbouring kinds and how to tell them apart
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Acute viral upper respiratory infection (common cold) - Self-limited illness, typically under about 10 days, often with sore throat or low-grade systemic symptoms; rhinitis is diagnosed when the nasal picture is recurrent or persistent without that acute infectious course.
- Acute or chronic rhinosinusitis (including CRSwNP) - EPOS requires facial pain/pressure or smell loss plus objective sinus involvement on endoscopy or imaging and, for chronic disease, ≥12 weeks; isolated mucosal rhinitis lacks that sinus evidence.
- Cerebrospinal-fluid rhinorrhoea - Unilateral watery drip that increases on leaning forward or Valsalva; fluid is positive for β2-transferrin or β-trace protein and is not accompanied by itch and sneezing.
- Nasal foreign body - Unilateral foul or bloody discharge, usually in a child; visible on anterior rhinoscopy or endoscopy.
- Adenoidal hypertrophy (children) - Persistent mouth breathing, snoring, and hyponasal speech with adenoid tissue on nasendoscopy, not an isolated mucosal inflammatory picture.
- Non-allergic versus allergic rhinitis (internal split that is still a differential) - Negative skin-prick tests and serum specific IgE (and, if local allergic rhinitis is suspected, a nasal allergen challenge) separate non-allergic disease from IgE-driven disease.
- Which of these neighbouring kinds and how to tell them apart hold for the sense of rhinitis this model covers, and on what evidence? provenance
Sources
- Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines - 2016 revision - Journal of Allergy and Clinical Immunology (AAAAI; GRADE update of the WHO-associated ARIA initiative) - Clinical definition, intermittent vs persistent and mild vs moderate-severe severity, comorbidity with asthma, and the shift away from purely seasonal/perennial labels.
- Rhinitis 2020: A practice parameter update - Journal of Allergy and Clinical Immunology (Joint Task Force of AAAAI and ACAAI) - Practical phenotype list used in North American clinics (allergic, nonallergic, mixed, occupational, drug-induced, NARES) and recommended diagnostic tests.
- BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017) - Clinical & Experimental Allergy (British Society for Allergy and Clinical Immunology) - UK diagnostic pathway, distinction from rhinosinusitis, and first-line intranasal corticosteroid / antihistamine practice.
- ICD-11 MMS code CA08 Rhinitis - World Health Organization - The current international statistical classification of rhinitis and its allergic and non-allergic children.
- European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020) - Rhinology (European Rhinologic Society / EPOS steering group) - The operational boundary between rhinitis and rhinosinusitis (duration, smell loss, facial pain, endoscopy or imaging).
What the second pass must settle
- Which authoritative definition and subtype taxonomy should this registry adopt, particularly for infectious, mixed and less common rhinitis presentations?
- Which duration and control classifications are applicable to each subtype and age group, and how should incompatible classification systems be represented?
- What evidence should justify specialist investigation for local allergic rhinitis when systemic sensitisation tests are negative but the history remains suggestive?
- Which validated symptom and quality-of-life measures, meaningful-change thresholds and reassessment intervals should be used across ages and languages?
- Which current jurisdiction-specific referral and treatment pathways should govern atypical presentations, pregnancy, young children and symptoms persisting despite an adequate treatment trial?