Published online: January 26, 2017
Chronic rhinosinusitis (CRS) is a persistent inflammatory condition of the sinuses. Immune deficiencies, particularly those which affect antibody number and/or antibody function, are commonly seen in patients with CRS. Specific antibody deficiency (SAD) is a functional antibody deficiency in which people are unable to make antibodies to polysaccharide antigens, such as those found in the vaccine, Pneumovax. The practice parameters classify SAD severity into severe, moderate, and mild depending on the number of functional antibodies produced in response to Pneumovax.
In a study published in The Journal of Allergy and Clinical Immunology: In Practice, Keswani and colleagues studied 595 patients with CRS who were evaluated for immune deficiency. The severity of CRS and the presence of comorbidities were evaluated to determine if there was a relationship between the severity of SAD and the severity of CRS. A separate group of 98 normal controls without recurrent infections were assessed for the presence of a functional antibody deficiency.
Of the 595 patients with CRS, 24% were diagnosed with SAD; in comparison, 11% of the normal population had low functional antibody production. 6% of the CRS patients had common variable immune deficiency and 1.5% had IgA deficiency. Patients with more severe SAD were more likely to have more severe asthma and a greater history of pneumonia. Patients with more severe SAD also required more antibiotic courses than patients with mild SAD. Patients with mild SAD and those without SAD required similar numbers of antibiotic courses.
This study demonstrates that physicians should consider screening for antibody deficiencies in CRS, particularly in those patients with coexistent lung disease or those that require frequent antibiotics for infections. Those with more severe SAD (fewer functional antibodies) were more likely to have worse disease as measured by number of antibiotic courses and also, a higher prevalence of pneumonia. This study suggests that incorporation of both clinical characteristics and laboratory evaluation is useful in the assessment of SAD severity.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.