In assessing the nature of nasal and/or conjunctival symptoms, the most similar alternative to an AR diagnosis is a cold. Aspects to consider include:9

·      How long have there been symptoms? A cold is usually over in two weeks, AR can persist or come and go in recurrent bouts;

·      Is there any suggestion of seasonality in the symptoms?

·      How did the symptoms appear? A cold tends to develop over hours or days, whereas AR symptoms can occur rapidly;

·      What are the nose/eye symptoms? (see below)

·      Is there a cough or sore throat? These are more typical of a cold, but can sometimes be a symptom in AR;

·      Is there chest discomfort? This is rare in AR unless allergic asthma is present; a cold can exacerbate asthma.

Nasal and ocular symptoms can help differentiate conditions. A cold may typically have congestion or a runny nose (rhinorrhoea), the mucus is (usually) more viscous and sneezing bouts are less likely. In AR, rhinorrhoea tends to be profuse and watery, which may stimulate several episodes of sneezing in quick succession.

Noses are rarely itchy with a cold, but nasal pruritis is common in AR. Similarly, eye symptoms are rare in colds, but eyes are often affected by AR and can be itchy, red, and teary. Loss of smell is not unusual in a cold, while a partial loss of smell is normally only seen in severe cases of AR.