8/18/03 Sinusitis and atopySummaryThere has been a continuing interest in the possible role of chronic allergic rhinitis (AR) in the pathogenesis of chronic sinusitis (CS). This subject was reviewed recently by Mucha and Baroody of the University of Chicago, Il. They described studies showing a 54-84% prevalence of AR in adults with CS. There is also atopic disease in 37% of children with sinusitis. Conversely, there is CT evidence of sinus inflammation (not necessarily symptomatic) in >50% of those with perennial AR, with a lesser frequency of CT sinus abnormalities in those with seasonal AR. However, some studies have shown sinus CT abnormalities in 60% of those with severe seasonal AR, even after nasal symptoms decreased with intranasal steroid therapy. Other studies have shown evidence of more severe and extensive sinus abnormalities in CS patients with associated AR than in those without associated AR. However, it should be emphasized that several studies have shown no correlation between the extent or severity of CT sinus abnormalities and the degree of patient symptomatology. Reference Curr Allergy Asthma Reports 2003; 3:232-37 Editor’s Comments This interesting discussion deals with a subject of increasing interest, investigation, and some controversy. Most investigators agree that sinus CT abnormalities suggesting CS can occur during active AR. However, in a limited number of studies, endoscopic biopsies have shown inflammation without definite signs of infection by histologic or culture criteria in many of such cases. A particular subset has been called allergic fungal sinusitis representing and exaggerated allergic-type inflammatory response to local fungal superficial invasion in the sinus. The frequency of this subset is a matter of debate. Molecular studies for bacterial RNA may provide additional evidence of bacterial colonization in the face of negative routine cultures. Obviously, further investigation is warranted.
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