Considerations for Referral

Unilateral rhinitis, nasal obstruction without other typical symptoms of AR

Purulent rhinitis, fever, marked facial or ear pain, or recurrent nose bleeds

Ocular symptoms without typical symptoms of AR Unilateral ocular symptoms, photophobia, or vision changes

Severe symptoms

Failure of therapy (nonresponse or adherence limiting side effects or intolerance) Desire to have specific allergen triggers identified (e.g., by skin testing) Candidates for immunotherapy

Concurrent asthma, nasal polyposis, sinusitis, or otitis media with effusion

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