Factors associated with a high-risk CRS phenotype with recurrent antibiotic use

Published online: January 28, 2020

Chronic rhinosinusitis (CRS) is a chronic inflammatory condition of the nose and paranasal sinuses with symptoms lasting 12 weeks or greater. The prevalence is estimated between 6% and 12% of the US population and is associated with reduced quality of life and significant economic burden. Patients with CRS suffer from acute exacerbations which are treated with systemic corticosteroids and oral antibiotics. Chronic sinusitis is one of the most common reasons for antibiotic prescriptions in the outpatient setting. Despite this, there is limited data identifying patients with CRS at risk for recurrent acute exacerbations requiring antibiotics.  

In an article recently published in The Journal of Allergy and Clinical Immunology (JACI), Kwah, Peters and colleagues retrospectively analyzed a cohort of patients with CRS to determine clinical characteristics which could distinguish patients with CRS experiencing frequent acute exacerbations defined as ≥4 courses of antibiotics in a 12-month period. Over 3000 patients were included in the study who had been evaluated at a large urban tertiary care center in Otolaryngology and Allergy and Immunology clinics.  

The study found that ~19% of patients with CRS experienced frequent acute exacerbations requiring recurrent courses of antibiotics. Asthma, allergic rhinitis, eosinophil count ≥150/μL, and autoimmune diseases were factors more likely to be associated with frequent acute exacerbations of CRS. Additionally, radiographic sinus disease severity, nasal polyposis, asthma severity, increased systemic corticosteroid use, antibody deficiency and antibiotic allergy were more likely to be associated with patients with frequent exacerbations of CRS.  

The study identified a high-risk CRS phenotype associated with asthma, allergic rhinitis, eosinophil count ≥150/μL, autoimmune disease, and other important clinical factors of allergic and immunologic diseases who have recurrent acute exacerbations needing antibiotics. This subgroup of patients with CRS at high-risk for recurrent exacerbations requiring frequent courses of antibiotics and steroids may benefit from targeted interventions to reduce exacerbation frequency and improve patient care.  

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

Graphical Abstract