{ "model": { "rank": 5907, "code": "thing-q114085", "model_id": "vr.tr.rhinitis", "name": "rhinitis", "purpose": "Enable an AI agent to recognise a rhinitis presentation, record its suspected causes and current burden, and support evidence-based assessment, management and reassessment.", "family": "Thing Registry", "category": "Information and virtual systems", "status": "research-draft", "kind": "thing", "plane": "INF", "domain": "INF.MED", "industry": "", "version": "", "url": "/models/thing/q114085/", "tier": 2, "score": 64, "payload": { "layer": "wikidata", "aliases": [ "upper airway cough syndrome", "greatly increased nasal secretions and oral secretions", "allergic rhinitis", "chronic rhinitis", "rhinitis medicamentosa", "runny nose", "seasonal allergic rhinitis", "perennial allergic rhinitis", "ragweed sensitivity", "rhinitis of pregnancy", "coryza", "Occupational rhinitis", "Honeymoon rhinitis", "post-nasal drip" ], "aliasCount": 14, "merged": 14, "knownIn": 64, "facets": null, "markers": [], "lexicalClass": "", "senseRank": null, "alsoRegisteredAs": null, "source": { "dataset": "wikidata", "item": "Q114085", "url": "https://www.wikidata.org/wiki/Q114085", "license": "CC0 1.0" } }, "research": { "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-07T10:02:05Z", "providers": [ "Codex", "Grok" ], "missingProviders": [], "pass": 2, "cost": { "grok": { "usd": 0.01096296, "turns": 1, "seconds": 143.9, "error": null }, "codex": { "seconds": 89.7, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.3\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a07b4c-fb0a-7df1-a938-ef3d6feca359\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: rhinitis\nRegistry id: vr.tr.rhinitis\nPlane / domain: INF / INF.KNW\nRegistry definition: (none recorded)\nNames folded into this entry: (none)\n\nA Vercy" } } }, "metaModel": { "id": "THING-Q114085", "registryId": "vr.tr.rhinitis", "name": "rhinitis", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "INF.KNW" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q114085/", "model": { "registry_id": "vr.tr.rhinitis", "name": "rhinitis", "purpose": "Enable an AI agent to recognise a rhinitis presentation, record its suspected causes and current burden, and support evidence-based assessment, management and reassessment.", "definition": "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.", "scope_statement": "This model owns the knowledge needed to describe and assess rhinitis under vr.tr.rhinitis: nasal symptom patterns, causal hypotheses, diagnostic evidence, functional impact and management response, with links to associated or alternative conditions.", "in_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" ], "out_of_scope": [ "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" ], "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." ], "characteristics": [ { "name": "Nasal symptom profile", "kind": "category", "unit_or_values": "Obstruction, anterior or posterior rhinorrhoea, sneezing, itching; each present, absent or unknown", "why_it_matters": "Establishes the presentation and identifies which symptoms require explanation or relief." }, { "name": "Symptom intensity", "kind": "measurement", "unit_or_values": "Named symptom scale, recorded range, recall period and assessment date", "why_it_matters": "Enables interpretable comparisons without combining incompatible scores." }, { "name": "Temporal pattern", "kind": "measurement", "unit_or_values": "Onset date, duration in days or weeks, symptomatic days per week and symptom-free intervals", "why_it_matters": "Distinguishes episodes, persistence and recurrence without assuming that seasonal symptoms are brief." }, { "name": "Laterality", "kind": "category", "unit_or_values": "Bilateral, alternating, persistent left, persistent right or unknown", "why_it_matters": "Helps identify presentations needing structural or other differential assessment." }, { "name": "Causal interpretation", "kind": "category", "unit_or_values": "Allergic, infectious, non-allergic, mixed or unresolved; multiple hypotheses permitted", "why_it_matters": "Prevents all rhinitis from being treated as hay fever." }, { "name": "Diagnostic certainty", "kind": "state", "unit_or_values": "Suspected, supported, clinician-established, disputed or unresolved, with evidence and date", "why_it_matters": "Separates observed symptoms from interpretations." }, { "name": "Trigger relationship", "kind": "relation", "unit_or_values": "Exposure linked to onset, worsening or improvement; latency, reproducibility and evidence", "why_it_matters": "Supports targeted exposure assessment and avoids assuming causality from coexistence." }, { "name": "Allergen sensitisation evidence", "kind": "relation", "unit_or_values": "Allergen, test method, result, laboratory units or interpretation, date and clinical concordance", "why_it_matters": "Preserves the distinction between a test result and a clinically relevant trigger." }, { "name": "Functional burden", "kind": "measurement", "unit_or_values": "Sleep disruption, affected activity days and named quality-of-life score with recall period", "why_it_matters": "Captures consequences that symptom counts alone may miss." }, { "name": "Current control", "kind": "state", "unit_or_values": "Controlled, partly controlled, uncontrolled or unassessed under a named assessment rule", "why_it_matters": "Supports reassessment while keeping control distinct from underlying severity." }, { "name": "Intervention response", "kind": "relation", "unit_or_values": "Intervention linked to symptom change, adverse effects, adherence, technique and observation interval", "why_it_matters": "Distinguishes an ineffective treatment from an inadequately implemented trial." } ], "affordances": [ "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" ] }, "sources": [ { "id": "aria-2016", "title": "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)", "url": "", "what_it_supports": "Clinical definition, intermittent vs persistent and mild vs moderate-severe severity, comorbidity with asthma, and the shift away from purely seasonal/perennial labels." }, { "id": "rhinitis-2020-pp", "title": "Rhinitis 2020: A practice parameter update - Journal of Allergy and Clinical Immunology (Joint Task Force of AAAAI and ACAAI)", "url": "", "what_it_supports": "Practical phenotype list used in North American clinics (allergic, nonallergic, mixed, occupational, drug-induced, NARES) and recommended diagnostic tests." }, { "id": "bsaci-2017", "title": "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)", "url": "", "what_it_supports": "UK diagnostic pathway, distinction from rhinosinusitis, and first-line intranasal corticosteroid / antihistamine practice." }, { "id": "icd11-ca08", "title": "ICD-11 MMS code CA08 Rhinitis - World Health Organization", "url": "https://icd.who.int/", "what_it_supports": "The current international statistical classification of rhinitis and its allergic and non-allergic children.", "url_status": "live" }, { "id": "epos-2020", "title": "European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020) - Rhinology (European Rhinologic Society / EPOS steering group)", "url": "", "what_it_supports": "The operational boundary between rhinitis and rhinosinusitis (duration, smell loss, facial pain, endoscopy or imaging)." } ], "structure": { "bundles": [ { "id": "nasal-presentation", "name": "Nasal presentation", "description": "Record the nasal manifestations that make rhinitis a plausible interpretation.", "rationale": "An agent needs a recognisable presentation before assigning a cause or judging treatment response.", "layers": [ { "id": "symptom-pattern", "name": "Symptom pattern", "description": "Describe the symptoms in the person's own terms and as clinically interpreted.", "findings": [ { "id": "core-nasal-manifestations", "name": "Core nasal manifestations", "description": "Record obstruction, discharge, sneezing and itching individually, including the dominant complaint.", "questions": [ { "text": "Which nasal symptoms are present, absent or unassessed, and which is most troublesome?", "kind": "definition", "id": "core-nasal-manifestations-q01" }, { "text": "How were symptom intensity, discharge characteristics and laterality observed or reported?", "kind": "measurement", "id": "core-nasal-manifestations-q02" } ] } ] }, { "id": "examination-and-attribution", "name": "Examination and attribution", "description": "Connect the reported presentation with dated examination evidence.", "findings": [ { "id": "nasal-assessment-evidence", "name": "Nasal assessment evidence", "description": "Preserve mucosal, turbinate and discharge observations separately from the diagnosis inferred from them.", "questions": [ { "text": "Who assessed the nasal cavity, when, by what method, and what was observed?", "kind": "provenance", "id": "nasal-assessment-evidence-q01" }, { "text": "Which observations support rhinitis, and which require an additional or alternative explanation?", "kind": "boundary", "id": "nasal-assessment-evidence-q02" } ] } ] } ] }, { "id": "causes-and-triggers", "name": "Causes and triggers", "description": "Represent competing or coexisting explanations for the nasal symptoms.", "rationale": "Rhinitis management depends on the supported mechanism and exposure relationship rather than the label alone.", "layers": [ { "id": "allergic-attribution", "name": "Allergic attribution", "description": "Relate suspected allergens to exposure history and relevant investigations.", "findings": [ { "id": "allergen-symptom-concordance", "name": "Allergen symptom concordance", "description": "Record sensitisation results separately from evidence that the allergen causes this person's symptoms.", "questions": [ { "text": "Which exposures precede symptoms reproducibly, and do symptoms change when the exposure ends?", "kind": "measurement", "id": "allergen-symptom-concordance-q01" }, { "text": "What skin or specific-IgE testing was performed, and how does its interpretation fit the exposure history?", "kind": "provenance", "id": "allergen-symptom-concordance-q02" } ] } ] }, { "id": "other-and-mixed-attributions", "name": "Other and mixed attributions", "description": "Capture infectious, irritant, occupational, medication-related and other non-allergic hypotheses.", "findings": [ { "id": "non-allergic-contributors", "name": "Non-allergic contributors", "description": "Record candidate contributors and their evidence without forcing a single exclusive subtype.", "questions": [ { "text": "How do symptoms relate to respiratory illness, workplace attendance, irritants, weather, meals, hormonal context or medicine use?", "kind": "measurement", "id": "non-allergic-contributors-q01" }, { "text": "What supports each contributor, and could allergic and non-allergic mechanisms coexist?", "kind": "boundary", "id": "non-allergic-contributors-q02" } ] } ] } ] }, { "id": "course-and-burden", "name": "Course and burden", "description": "Describe how rhinitis evolves and how much it disrupts the person's life.", "rationale": "Frequency, intensity and functional impact inform different aspects of assessment and must remain distinguishable.", "layers": [ { "id": "episode-and-recurrence", "name": "Episode and recurrence", "description": "Represent onset, persistence, symptom-free intervals and exposure-linked recurrence.", "findings": [ { "id": "temporal-classification", "name": "Temporal classification", "description": "Retain raw timing observations alongside any classification and its stated rule.", "questions": [ { "text": "When did symptoms begin, how many days per week occur, and how long are symptom-free intervals?", "kind": "measurement", "id": "temporal-classification-q01" }, { "text": "Which definition supports any acute, chronic, intermittent, persistent or seasonal label, and does it apply to the suspected subtype?", "kind": "definition", "id": "temporal-classification-q02" } ] } ] }, { "id": "impact-and-control", "name": "Impact and control", "description": "Assess symptom burden and impairment under the current management conditions.", "findings": [ { "id": "rhinitis-functional-impact", "name": "Rhinitis functional impact", "description": "Record sleep, work, school and activity effects alongside the person's treatment goals.", "questions": [ { "text": "Over what recall period did nasal symptoms disrupt sleep, concentration, work, school or usual activities?", "kind": "measurement", "id": "rhinitis-functional-impact-q01" }, { "text": "What symptom or activity outcome would count as acceptable control for this person?", "kind": "action", "id": "rhinitis-functional-impact-q02" } ] } ] } ] }, { "id": "diagnostic-boundaries-and-escalation", "name": "Diagnostic boundaries and escalation", "description": "Identify presentations that need another model or additional clinical assessment.", "rationale": "A rhinitis label must not absorb structural disease, sinus disease or important associated airway problems.", "layers": [ { "id": "alternative-nasal-causes", "name": "Alternative nasal causes", "description": "Assess atypical features and evidence for overlapping or alternative nasal disorders.", "findings": [ { "id": "atypical-presentation-review", "name": "Atypical presentation review", "description": "Preserve unilateral symptoms, bleeding, pain, smell change and unusual watery discharge as explicit assessment inputs.", "questions": [ { "text": "Are persistent unilateral obstruction, bleeding, marked pain or unusual watery discharge present, including any relevant trauma or surgery history?", "kind": "boundary", "id": "atypical-presentation-review-q01" }, { "text": "What assessment or referral is indicated by the specific findings under the applicable clinical pathway?", "kind": "action", "id": "atypical-presentation-review-q02" } ] } ] }, { "id": "associated-airway-and-eye-conditions", "name": "Associated airway and eye conditions", "description": "Link associated conditions while preserving their separate assessment and management.", "findings": [ { "id": "associated-condition-status", "name": "Associated condition status", "description": "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/)", "questions": [ { "text": "Which associated conditions are reported, suspected or diagnosed, and what evidence supports those states?", "kind": "provenance", "id": "associated-condition-status-q01" }, { "text": "Which symptoms or management needs belong to the associated condition rather than rhinitis?", "kind": "boundary", "id": "associated-condition-status-q02" } ] } ] } ] }, { "id": "management-and-reassessment", "name": "Management and reassessment", "description": "Connect management choices to the supported cause, patient context and observed outcomes.", "rationale": "An agent must be able to explain why an action is appropriate and what evidence would justify continuing or changing it.", "layers": [ { "id": "management-fit", "name": "Management fit", "description": "Record the rationale and prerequisites for exposure measures, medicines or specialist assessment.", "findings": [ { "id": "rhinitis-action-selection", "name": "Rhinitis action selection", "description": "Tie each proposed intervention to a target symptom or contributor and to applicable clinical guidance.", "questions": [ { "text": "Which supported contributor or troublesome symptom is the proposed intervention intended to address?", "kind": "action", "id": "rhinitis-action-selection-q01" }, { "text": "What age, pregnancy, comorbidity, concurrent medicine or patient-preference factors affect its suitability?", "kind": "boundary", "id": "rhinitis-action-selection-q02" }, { "text": "Which guideline or clinician decision supports the action, and what evidence is still needed before proceeding?", "kind": "provenance", "id": "rhinitis-action-selection-q03" } ] } ] }, { "id": "response-and-revision", "name": "Response and revision", "description": "Interpret outcomes in light of actual use, delivery technique and changing exposures.", "findings": [ { "id": "adequate-trial-and-next-step", "name": "Adequate trial and next step", "description": "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/)", "questions": [ { "text": "What changed after treatment, over what interval, and with what adherence, nasal delivery technique and exposure changes?", "kind": "measurement", "id": "adequate-trial-and-next-step-q01" }, { "text": "Does the evidence support continuing, correcting use, reviewing medication-related worsening, reconsidering the cause or obtaining specialist assessment?", "kind": "action", "id": "adequate-trial-and-next-step-q02" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "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" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of rhinitis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ { "scheme": "Wikidata", "value_or_pattern": "Q114085", "note": "Item for rhinitis as a disease; allergic rhinitis is a separate item (commonly Q190815)." }, { "scheme": "ICD-11 MMS", "value_or_pattern": "CA08 (Rhinitis); CA08.0 Allergic rhinitis; CA08.1 Non-allergic rhinitis", "note": "WHO statistical classification; acute common cold is coded elsewhere (CA00)." }, { "scheme": "ICD-10", "value_or_pattern": "J30 (vasomotor and allergic rhinitis, with J30.0-J30.4 children); J31.0 Chronic rhinitis", "note": "Still the billing code set in many jurisdictions; acute infectious rhinitis is often J00." }, { "scheme": "SNOMED CT", "value_or_pattern": "70076002 |Rhinitis (disorder)|", "note": "Clinical terminology; allergic, vasomotor and other subtypes have their own concept IDs under this parent." }, { "scheme": "MeSH", "value_or_pattern": "D012220", "note": "Rhinitis; Hay Fever / allergic rhinitis is D006255." }, { "scheme": "UMLS CUI", "value_or_pattern": "C0035455", "note": "Maps the MeSH/SNOMED rhinitis cluster." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of rhinitis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-standards-and-regulation", "name": "Standards and regulation", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "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." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of rhinitis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "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." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of rhinitis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-measurements", "name": "Typical measurements", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ { "quantity": "Total Nasal Symptom Score (TNSS): congestion + rhinorrhea + sneezing + itching, each 0-3", "typical_range": "0-12; trial entry often ≥6-8", "unit": "score" }, { "quantity": "Nasal symptom visual analogue scale (ARIA)", "typical_range": "0-10; <5 often treated as mild, ≥5 as moderate-severe", "unit": "cm" }, { "quantity": "Peak nasal inspiratory flow (PNIF)", "typical_range": "roughly 80-200 in unobstructed adults; values below about 70-80 suggest obstruction (age- and sex-dependent)", "unit": "L/min" }, { "quantity": "Serum specific IgE (ImmunoCAP-type assays)", "typical_range": "negative cutoff commonly <0.35; sensitised patients from 0.35 to >100", "unit": "kUA/L" }, { "quantity": "Skin-prick test wheal (mean diameter vs saline control)", "typical_range": "positive usually ≥3 mm greater than negative control", "unit": "mm" }, { "quantity": "Nasal-smear eosinophils (NARES phenotype)", "typical_range": "often quoted as >20% of recovered leukocytes, cut-offs vary by lab", "unit": "%" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of rhinitis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "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." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of rhinitis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-regional-variation", "name": "Regional variation", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ "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." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of rhinitis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Reported by the breadth pass; each item needs checking against its source before it becomes normative.", "evidence": [ { "name": "Acute viral upper respiratory infection (common cold)", "difference": "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." }, { "name": "Acute or chronic rhinosinusitis (including CRSwNP)", "difference": "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." }, { "name": "Cerebrospinal-fluid rhinorrhoea", "difference": "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." }, { "name": "Nasal foreign body", "difference": "Unilateral foul or bloody discharge, usually in a child; visible on anterior rhinoscopy or endoscopy." }, { "name": "Adenoidal hypertrophy (children)", "difference": "Persistent mouth breathing, snoring, and hyponasal speech with adenoid tissue on nasendoscopy, not an isolated mucosal inflammatory picture." }, { "name": "Non-allergic versus allergic rhinitis (internal split that is still a differential)", "difference": "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." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of rhinitis this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "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?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 18, "questions": 29 } }, "draft": { "generator": "vr.draft.v3", "status": "draft-generated", "researched": false, "archetype": "disease or condition", "method": "Written from the archetype playbook - what this kind of thing needs beyond identity and provenance - and from the structure that recurred across 6,333 models already researched by two engines. Applied to this entry by rule. No source was read for this thing and no claim here is researched. This entry carries no facets of its own, so they were inferred from its domain - a guess about a whole domain applied to one thing.", "facetsInferred": true, "nextPass": "A researcher replaces this draft with a sourced specification. Treat every sentence below as a proposal to argue with.", "purpose": "Give an agent a durable, checkable way to recognise a rhinitis, record what state it is in, and decide what may be done with it.", "whatItIs": "Enable an AI agent to recognise a rhinitis presentation, record its suspected causes and current burden, and support evidence-based assessment, management and reassessment.", "characteristics": { "substance": "information", "origin": "conceptual", "agency": "inert" }, "whatYouCanDoWithIt": [ "read and interpreted", "observed and measured" ], "distinguishingFeatures": [ "Names folded into this entry, which a task may need to split apart again: upper airway cough syndrome, greatly increased nasal secretions and oral secretions, allergic rhinitis, chronic rhinitis, rhinitis medicamentosa, runny nose, seasonal allergic rhinitis, perennial allergic rhinitis, ragweed sensitivity, rhinitis of pregnancy, coryza, Occupational rhinitis.", "14 finer distinctions are held as aliases rather than separate entries, because telling them apart needs a task that asks for it.", "Described in 64 Wikipedia languages, which is a measure of how widely the thing is known, not of how important it is." ], "openQuestionsForResearch": [ "Which of the bundles below does a real task actually need, and which are ceremony?", "What does this thing have that the facets do not capture at all?", "Which neighbouring kind is most often confused with a rhinitis, and on what evidence are they told apart?" ], "whatItIsMadeOf": "content that has to be carried by something else", "physicalCharacter": [ "Does nothing on its own; everything it does, something else did to it.", "These come from the domain this entry sits in rather than from the entry itself, so treat them as a first guess about the whole domain applied to one thing." ], "whatCanBeDoneWithIt": [ "read it and act on what it says", "observe it, measure it, record its state" ], "howItIsRecognised": [ "Recognised by criteria applied to signs and findings, not by appearance. Two conditions can look identical and be distinguished only by test." ], "relatedModels": [ { "relation": "covers", "note": "Finer kinds folded into this entry because telling them apart needs a task that asks for it. Each is a model waiting to be split out when one does.", "targets": [ "upper airway cough syndrome", "greatly increased nasal secretions and oral secretions", "allergic rhinitis", "chronic rhinitis", "rhinitis medicamentosa", "runny nose", "seasonal allergic rhinitis", "perennial allergic rhinitis", "ragweed sensitivity", "rhinitis of pregnancy", "coryza", "Occupational rhinitis" ] } ], "standing": "Described in 64 Wikipedia languages, which measures how widely it is written about rather than how important or how common it is. 14 finer distinctions are held inside this entry as names rather than as separate models.", "structure": { "bundles": [ { "id": "identity-and-classification", "name": "Identity, naming and classification", "description": "How an agent tells one rhinitis from another, and a rhinitis from things that resemble it.", "rationale": "Recognition comes before every other claim. Without stable identity nothing else in the model can be trusted to be about the same thing twice.", "layers": [ { "id": "naming-and-identifiers", "name": "Names and identifiers", "description": "The names this thing goes by and the identifiers that survive translation and time.", "findings": [ { "id": "preferred-name-and-aliases", "name": "Preferred name, aliases and local names", "description": "Which name to use, which names mean the same thing, and which merely sound similar.", "questions": [ { "id": "preferred-name-and-aliases-q01", "text": "What identifies and describes the name of a rhinitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "preferred-name-and-aliases-q02", "text": "Who or what asserted this about the name of a rhinitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "preferred-name-and-aliases-q03", "text": "What may an agent decide or do once the name of a rhinitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] }, { "id": "stable-identifiers", "name": "Stable identifiers and external keys", "description": "Identifiers that keep pointing at this kind of thing across systems and languages.", "questions": [ { "id": "stable-identifiers-q01", "text": "What identifies and describes an identifier for a rhinitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "stable-identifiers-q02", "text": "Who or what asserted this about an identifier for a rhinitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "stable-identifiers-q03", "text": "What may an agent decide or do once an identifier for a rhinitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "classification-and-granularity", "name": "Classification and granularity", "description": "Where a rhinitis sits among kinds, and how finely a task needs to cut it.", "findings": [ { "id": "kind-and-parents", "name": "Kind, parents and neighbouring kinds", "description": "The classes this thing belongs to and the ones it is next to.", "questions": [ { "id": "kind-and-parents-q01", "text": "What identifies and describes the kind of a rhinitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "kind-and-parents-q02", "text": "Who or what asserted this about the kind of a rhinitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "kind-and-parents-q03", "text": "What may an agent decide or do once the kind of a rhinitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] }, { "id": "distinguishing-features", "name": "Distinguishing features", "description": "What separates a rhinitis from the things most often confused with it.", "questions": [ { "id": "distinguishing-features-q01", "text": "What identifies and describes what distinguishes a rhinitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "distinguishing-features-q02", "text": "Who or what asserted this about what distinguishes a rhinitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "distinguishing-features-q03", "text": "What may an agent decide or do once what distinguishes a rhinitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] }, { "id": "state-and-lifecycle", "name": "State and lifecycle", "description": "The states a rhinitis passes through and the events that move it between them.", "rationale": "Most decisions about a thing depend on what state it is in now, which is a claim with a time on it, not a property.", "layers": [ { "id": "lifecycle-stages", "name": "Lifecycle stages", "description": "From coming into existence to ceasing to be one of these.", "findings": [ { "id": "stages-and-transitions", "name": "Stages and transitions", "description": "The stages worth naming and what moves a rhinitis between them.", "questions": [ { "id": "stages-and-transitions-q01", "text": "What identifies and describes the lifecycle of a rhinitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "stages-and-transitions-q02", "text": "Who or what asserted this about the lifecycle of a rhinitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "stages-and-transitions-q03", "text": "What may an agent decide or do once the lifecycle of a rhinitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "observations-and-status", "name": "Observations and current status", "description": "What is observed about a rhinitis, how often and by whom.", "findings": [ { "id": "observation-record", "name": "Observation record", "description": "How an observation of a rhinitis is recorded so that it can be superseded rather than overwritten.", "questions": [ { "id": "observation-record-q01", "text": "What identifies and describes an observation of a rhinitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "observation-record-q02", "text": "Who or what asserted this about an observation of a rhinitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "observation-record-q03", "text": "What may an agent decide or do once an observation of a rhinitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] }, { "id": "content-and-access", "name": "Content, encoding and access", "description": "What a rhinitis says, how it is encoded and who may read it.", "rationale": "An informational thing carries content that can be copied, versioned and withheld, none of which its physical carrier explains.", "layers": [ { "id": "content-and-encoding", "name": "Content and encoding", "description": "The content itself, its format and its language.", "findings": [ { "id": "content-and-format", "name": "Content, format and language", "description": "What a rhinitis contains and in what form it is held.", "questions": [ { "id": "content-and-format-q01", "text": "What identifies and describes the content of a rhinitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "content-and-format-q02", "text": "Who or what asserted this about the content of a rhinitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "content-and-format-q03", "text": "What may an agent decide or do once the content of a rhinitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "access-and-rights", "name": "Access, rights and retention", "description": "Who may read, copy or change it, and for how long it is kept.", "findings": [ { "id": "access-rules", "name": "Access rules and retention", "description": "The permissions attached to a rhinitis and the period it survives.", "questions": [ { "id": "access-rules-q01", "text": "What identifies and describes access to a rhinitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "access-rules-q02", "text": "Who or what asserted this about access to a rhinitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "access-rules-q03", "text": "What may an agent decide or do once access to a rhinitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] }, { "id": "diagnosis-and-criteria", "name": "Diagnosis, criteria and coding", "description": "What makes a case of rhinitis a case, and under which revision.", "rationale": "Criteria change between revisions, so a diagnosis without its coding revision cannot be compared with a later one.", "layers": [ { "id": "criteria", "name": "Diagnostic criteria", "description": "The criteria in force and who issues them.", "findings": [ { "id": "criteria-record", "name": "Criteria, issuer and revision", "description": "What must be true for a diagnosis, according to whom.", "questions": [ { "id": "criteria-record-q01", "text": "What criteria define rhinitis, issued by which body, in which revision?", "kind": "definition" }, { "id": "criteria-record-q02", "text": "What changed between revisions that would reclassify existing cases?", "kind": "boundary" } ] } ] }, { "id": "coding", "name": "Coding and terminology", "description": "The codes used to record it and their mapping.", "findings": [ { "id": "coding-record", "name": "Codes and mappings", "description": "Which classification codes apply and how they map.", "questions": [ { "id": "coding-record-q01", "text": "Which classification and terminology codes cover rhinitis, and how do they map to each other?", "kind": "definition" }, { "id": "coding-record-q02", "text": "What is lost when a case is mapped from one scheme to another?", "kind": "boundary" } ] } ] } ] }, { "id": "course-and-population", "name": "Course, population and care", "description": "How rhinitis develops, whom it affects, and what is done about it.", "rationale": "The condition, the diagnosis and the episode of care are three different things, and an agent must not merge them.", "layers": [ { "id": "course", "name": "Course and stages", "description": "Onset, progression, remission and outcome.", "findings": [ { "id": "course-record", "name": "Stages and transitions", "description": "The stages recorded and what moves a case between them.", "questions": [ { "id": "course-record-q01", "text": "What course does rhinitis typically take, and what marks each stage?", "kind": "definition" }, { "id": "course-record-q02", "text": "What separates the condition itself from an episode of care for it?", "kind": "boundary" } ] } ] }, { "id": "population", "name": "Affected populations", "description": "Who is affected, how often, and on what evidence.", "findings": [ { "id": "epidemiology", "name": "Prevalence and its basis", "description": "Rates with their population, period and source.", "questions": [ { "id": "epidemiology-q01", "text": "What prevalence or incidence is reported for rhinitis, in which population and period?", "kind": "measurement" }, { "id": "epidemiology-q02", "text": "What may an agent not conclude about an individual from a population rate?", "kind": "action" } ] } ] } ] }, { "id": "provenance-and-evidence", "name": "Provenance, evidence and time", "description": "Where every claim about a rhinitis came from and when it held.", "rationale": "A claim without a source and a time cannot be superseded, only overwritten, and an agent that overwrites loses the ability to explain itself.", "layers": [ { "id": "source-and-authority", "name": "Source and authority", "description": "Who said it, on what evidence, and how strongly.", "findings": [ { "id": "claim-provenance", "name": "Claim provenance and confidence", "description": "The authority behind each claim about a rhinitis and how confident it is.", "questions": [ { "id": "claim-provenance-q01", "text": "What identifies and describes a claim about a rhinitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "claim-provenance-q02", "text": "Who or what asserted this about a claim about a rhinitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "claim-provenance-q03", "text": "What may an agent decide or do once a claim about a rhinitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] }, { "id": "time-and-versions", "name": "Time, versions and supersession", "description": "When a claim was true, when it was learnt, and what replaced it.", "findings": [ { "id": "validity-and-supersession", "name": "Validity period and supersession", "description": "How an old claim about a rhinitis is retired without being erased.", "questions": [ { "id": "validity-and-supersession-q01", "text": "What identifies and describes the validity of a claim about a rhinitis, and in what units or vocabulary?", "kind": "definition", "answer_data": [ "identifiers", "types and classes", "values with units", "explicit unknowns" ] }, { "id": "validity-and-supersession-q02", "text": "Who or what asserted this about the validity of a claim about a rhinitis, by which method, and when was it true?", "kind": "provenance", "answer_data": [ "authority", "method", "evidence", "event time", "knowledge time" ] }, { "id": "validity-and-supersession-q03", "text": "What may an agent decide or do once the validity of a claim about a rhinitis is known, and what must it refuse?", "kind": "action", "answer_data": [ "permitted actions", "preconditions", "refusals", "escalation" ] } ] } ] } ] } ] }, "statistics": { "bundles": 6, "layers": 12, "findings": 14, "questions": 38 } } } }