5th International Conference on ENT: Head and Neck Surgery

Fatima Ali is an Assistant Professor in the Department of Medicine at Kuwait University, Kuwait. She completed her specialty training in Allergy and Immunology at the University of California, Davis, USA. Her clinical and academic interests include allergic diseases, immunopathology, and clinical allergy. Her work focuses on the evaluation and management of allergic and immune-mediated disorders, with particular interest in translating advances in immunology into clinical practice.

Rhinitis is one of the most common conditions encountered by both allergists and otolaryngologists. Although many patients respond well to standard therapy, a significant proportion continue to experience persistent nasal obstruction, rhinorrhea, sneezing, itching, or postnasal symptoms despite appropriate treatment. These patients frequently represent a diagnostic and therapeutic challenge.

This presentation will provide an allergist’s approach to the difficult rhinitis patient, with particular emphasis on issues relevant to the otolaryngologist. The differential diagnosis of persistent rhinitis will be reviewed, including inadequately controlled allergic rhinitis, local allergic rhinitis, non-allergic rhinitis, mixed rhinitis, medication-related disease, and chronic rhinosinusitis. Particular attention will be given to patients with a convincing allergic history despite negative systemic allergy testing and to distinguishing inflammatory from structural causes of persistent nasal symptoms.

The presentation will also highlight important red flags and uncommon conditions that may masquerade as allergic rhinitis and should prompt alternative diagnostic evaluation. The roles of targeted allergy testing, optimized pharmacotherapy, allergen immunotherapy, and multidisciplinary management will be discussed.

Finally, the overlap between rhinitis, asthma, chronic rhinosinusitis with nasal polyps, and type 2 inflammation will be explored, including situations in which biologic therapy may be relevant.

A structured, phenotype-based approach to the difficult rhinitis patient can improve diagnostic accuracy, avoid inappropriate treatment escalation, and promote effective collaboration between allergists and otolaryngologists.