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Does a subtype of chronic sinusitis begin in early life?

Published online: January 17, 2018

Chronic rhinosinusitis (CRS) is estimated to affect more than 10% of the adult population in the United States (US) and Europe. Asthma and allergic rhinitis commonly co-occur with CRS and increase the morbidity of the disease. Although medical and surgical therapies can relieve the symptoms of disease, approximately 25% of those with CRS fail to improve. There is a critical need to understand the pathogenesis of CRS, so that we can identify and treat individuals before the occurrence of irreversible chronic inflammatory and infectious changes to the sinus epithelium.

In an original article recently published in The Journal of Allergy & Clinical Immunology (JACI), Chang and colleagues hypothesized that the diagnosis of sinusitis in children up to age six would be a risk factor for the diagnosis of adult sinusitis. They used data collected on more than 700 individuals in whom sinusitis data was available at childhood and in the adult years from ages 22-32 from the Tucson Children’s Respiratory Study (TCRS).

The researchers analyzed the association between childhood sinusitis and the development of adult sinusitis and co-occurring asthma in the TCRS population. The TCRS is the longest ongoing birth cohort study centered on airway disease with in depth evaluations of participants from birth to age 35 at regular intervals. There is detailed information in the first six years of life on respiratory infections, allergy skin prick testing, pulmonary function testing, and questionnaires on airway disease. Approximately 11% of children had been diagnosed by a physician to have sinusitis by age six, providing a useful population to study longitudinally.

The authors showed that the diagnosis of childhood sinusitis was the most significant risk factor in developing adult sinusitis (OR=3.2, p=.001). Subjects with childhood sinusitis that persisted into adult life (early-onset chronic sinusitis) had increased serum IgE levels as early as at 9 months of age, were more likely to have maternal asthma, to be atopic (as assessed by skin test reactivity) and to have eczema and/or allergic rhinitis at age 6 and were markedly more likely to develop subsequent asthma. No early life risk factor could be identified for late-onset adult sinusitis. The authors’ findings suggest for the first time that establishment of a type 2 immune response during the preschool years may account for a common pathogenesis underlying the co-occurrence of allergic rhinitis, asthma, and early-onset chronic sinusitis.

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