A focused allergy exam looks head‑to‑toe, with special attention to skin, eyes, nose, throat, chest, and general appearance.

Key exam areas (big picture)

  • General: Ill vs well appearing, distress, breathing effort, voice changes, ability to speak full sentences.
  • Skin: Rashes, hives, swelling (angioedema), eczema or other signs of atopy.
  • ENT: Classic allergic rhinitis signs in nose, eyes, ears, throat, and sinuses.
  • Chest: Wheeze, prolonged expiration, work of breathing (for asthma/anaphylaxis).

General appearance and vitals

On first look you’d watch for:

  • Respiratory distress: Labored breathing, use of accessory muscles, tripod position, inability to lie flat.
  • Voice and speech: Hoarseness, stridor, difficulty talking, broken sentences suggesting airway compromise.
  • Level of alertness and perfusion: Pallor, diaphoresis, dizziness or near‑syncope in severe reactions.
  • Vitals (in a real clinical setting): Tachycardia, hypotension, tachypnea, hypoxia → red flags for anaphylaxis.

For a mild allergy clinic visit, the patient often looks generally well but may be constantly sniffing, clearing the throat, or rubbing their nose or eyes.

Skin findings to look for

Allergy is often visible on the skin:

  • Urticaria (hives): Raised, itchy wheals that are red or lighter/darker than surrounding skin, often transient and migratory.
  • Angioedema: Deeper swelling of lips, eyelids, tongue, face, or extremities.
  • Eczema/atopic dermatitis: Dry, scaly, lichenified patches, commonly in flexural areas; suggests an atopic background.
  • Generalized erythema or flushing: Can accompany systemic reactions or physical urticarias (heat, cold, pressure).
  • Scratching marks and excoriations: Evidence of chronic itch and atopy.

These findings help distinguish simple localized contact reactions from systemic allergy or anaphylaxis.

Head, eyes, nose, throat, and ears

Outward/behavioral signs

  • Persistent mouth breathing.
  • “Allergic salute”: Repeated upward rubbing of the nose, sometimes creating a transverse nasal crease.
  • Frequent sniffling or throat clearing.
  • “Allergic shiners”: Dark infraorbital circles from venous congestion under the eyes.

Eyes

  • Conjunctival injection and chemosis: Red, watery, puffy conjunctiva.
  • Periorbital edema: Puffy eyelids, often with itching.
  • Excess tearing and evidence of eye rubbing.

Nose

On external and internal nasal exam, you’d look for:

  • Mucosal swelling/edema: Boggy, edematous turbinates.
  • Color and character of secretions: Pale, bluish mucosa with thin, clear or watery discharge is classic for allergic rhinitis.
  • Structural issues: Deviated septum, hypertrophied turbinates, or nasal polyps which are common comorbid findings in chronic allergy.
  • Evidence of chronic irritation: Crusting, occasional minor bleeding from constant blowing or rubbing.

Throat and posterior oropharynx

  • Postnasal drip: Visible mucus trails on the posterior pharynx.
  • “Cobblestoning”: Lymphoid hyperplasia on the posterior pharyngeal wall from chronic irritation.
  • Tonsillar hypertrophy and chronic pharyngeal erythema from mouth breathing and postnasal drainage.

Ears and sinuses

  • Ears: Often normal, but you’d check with pneumatic otoscopy for Eustachian tube dysfunction or middle‑ear effusion.
  • Sinuses: Tenderness on palpation over frontal/maxillary sinuses, or referred pain like maxillary tooth sensitivity in associated sinusitis.

Chest and respiratory exam

If respiratory allergy, asthma, or anaphylaxis is suspected, you’d focus on:

  • Auscultation: Wheezing (especially expiratory), decreased air entry, or silent chest in very severe bronchospasm.
  • Work of breathing: Nasal flaring, intercostal/supraclavicular retractions, prolonged expiratory phase.
  • Cough: Dry, spasmodic, or triggered by deep inspiration or exposure to suspected allergen.
  • In some clinics, simple lung function measures (like peak flow or spirometry) are assessed as part of the “physical exam” to quantify obstruction.

In anaphylaxis, you’d also look for stridor, noisy breathing, and rapidly progressing wheeze or cough, plus hypotension signs.

Putting it together: an organized checklist

If you’re answering “what physical exam findings would you look for in a patient with allergies” (for study or a case question), an organized way to phrase it is:

  1. General
    • Overall distress, respiratory effort, ability to speak, mental status, vital sign abnormalities suggesting anaphylaxis.
  1. Skin
    • Urticaria, angioedema (lips, eyelids, tongue, face), flushing, atopic dermatitis lesions, excoriations from scratching.
  1. Eyes
    • Conjunctival injection, chemosis, tearing, itching, periorbital edema, allergic shiners.
  1. Nose
    • Boggy, edematous, pale/blue nasal mucosa; clear, thin rhinorrhea; nasal crease; nasal polyps or turbinate hypertrophy.
  1. Throat/oropharynx
    • Postnasal drip, cobblestoning of posterior pharynx, tonsillar hypertrophy, mouth breathing, chronic throat clearing.
  1. Ears and sinuses
    • Middle‑ear effusion or retraction on otoscopy; sinus tenderness or maxillary tooth sensitivity.
  1. Chest
    • Wheezing, decreased air entry, prolonged expiration, signs of increased work of breathing; in severe reactions, signs of respiratory failure or shock.

Simple HTML table of classic findings

[8][4] [5][2][8][4] [9][4] [1][9][4] [4] [4] [10][8][4]
Region Key allergy exam findings
General Well vs toxic appearance, respiratory distress, voice changes, hypotension signs in anaphylaxis.
Skin Hives (urticaria), angioedema of lips/eyelids/face, flushing, atopic dermatitis patches, excoriations.
Eyes Red, watery conjunctiva, chemosis, periorbital edema, allergic shiners, frequent rubbing.
Nose Pale, boggy mucosa, clear thin rhinorrhea, nasal crease from rubbing, polyps, turbinate hypertrophy.
Throat Postnasal drip, cobblestoning of posterior pharynx, enlarged tonsils, mouth breathing.
Ears/Sinuses Middle-ear effusion or retraction, sinus tenderness, maxillary tooth sensitivity in sinus involvement.
Chest Wheezing, decreased air entry, prolonged expiration, increased work of breathing, signs of anaphylaxis in severe reactions.

Information gathered from public forums or data available on the internet and portrayed here.