Sensitivity and Specificity of a Clinical Diagnosis of Allergic Rhinitis in Childhood

Rationale: We sought to evaluate the sensitivity and specificity of a clinical diagnosis of allergic rhinitis, using history and physical, to identify skin test positive rhinitis.

Methods: Participants were enrolled in the Tucson Children’s Respiratory Study, a non-selected birth cohort. Allergy skin prick testing (SPT) was performed at ages 6 and 11 years using bermuda, mesquite, olive, mulberry, careless weed, and Alternaria aeroallergens. Atopy was defined as ≥1 positive skin test. Active rhinitis was determined by questionnaire with reported symptoms within one year. “Allergic” rhinitis was defined if the caregiver reported a physician diagnosis of allergy.  “Atopic” rhinitis was defined as skin test positive rhinitis irrespective of physician diagnosis. 

Results: Among 320 participants with active rhinitis at age 6, 52% (n=167) had atopic rhinitis, and of these, 86% (143/167) were correctly identified as allergic rhinitis. Of the 48% (n=153) with non-atopic rhinitis, 80% were identified as allergic, while only 20% were correctly identified as non-allergic.  At age 11 (n=280), 71% (n=198) had atopic rhinitis with 92% (182/198) correctly identified as allergic. Of the 29% (n=82) with non-atopic rhinitis, 88% were identified as allergic, while only 12% were correctly identified as non-allergic.  The sensitivity and specificity of physician diagnosed allergic rhinitis at age 6 were 86% and 20%, respectively. Similarly, sensitivity and specificity at age 11 were 92% and 12%, respectively.  

Conclusions: Physicians overly diagnose rhinitis as allergic when using clinical criteria in children with nasal symptoms. Objective measurement of specific IgE is necessary to make an accurate diagnosis of allergic rhinitis.