Immune problems in chronic rhinosinusitis

Published Online: March 2, 2015

Chronic rhinosinusitis (CRS)—inflammation of the sinuses—is a common problem affecting more than 30 million Americans. Antibody deficiencies are immune problems that may predispose individuals to recurrent or chronic sinus infections. Specific antibody deficiency (SAD) is a type of immune problem where patients form normal quantities of antibodies, but the antibodies don’t function well. The role of SAD in CRS is unclear.

In the October issue of The Journal of Allergy and Clinical Immunology: In Practice, Kashani and colleagues describe SAD in patients with CRS.

They found that 23% of patients with CRS who were evaluated for immune problems had SAD. Patients with SAD received more antibiotic courses compared to patients with CRS who had an intact immune system, and 18% of these patients were treated with immune globulin, which contains normal IgG immunoglobulins from healthy individuals. However, the treatment of patients with SAD is not well defined. In this group, it seems that patients with the most severe version of SAD also tended to have more problems with their lungs, such as pneumonia, and were the group most likely to receive immune globulin.

As suggested by the higher number of antibiotic courses, this study indicates that a subgroup of patients with CRS have immune problems and may have worse disease. Physicians treating CRS need to be aware of and assess for immune problems. However, only 18% of patients with SAD and CRS needed intensive treatment with immune globulin replacement in this patient group.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI focusing on practical information for the practicing clinician.

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