Atopy common in severe chronic sinusitis patients

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82% of 125 chronic sinusitis patients who underwent surgery - and therefore were severe cases refractory to medications - were found to have skin reactions to one or more of the 24 most common inhalant allergens. This is about the same proportion than that found in allergic rhinitis patients, and the results were more pronounced in patients with nasal polyps.--------------Int Forum Allergy Rhinol. 2011 Mar;1(2):88-94.Atopic profile of patients failing medical therapy for chronic rhinosinusitis.Tan BK, Zirkle W, Chandra RK, Lin D, Conley DB, s AT, Grammer LC, Schleimer RP, Kern RC.SourceDepartment of Otolaryngology, Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.AbstractBACKGROUND:Chronic rhinosinusitis (CRS) is an inflammatory condition of the nasal airway and paranasal sinuses that can broadly be classified into Chronic rhinosinusitis with Nasal Polyps (CRSwNP) and Chronic rhinosinusitis without Nasal Polyps (CRSsNP). The relationship between CRS and atopy to inhalant allergens remains unclear. We sought to examine the presence of atopy in patients failing medical therapy for both types of CRS.OBJECTIVE:To analyze the frequency and distribution of allergen sensitivity in patients failing medical therapy for CRSwNP and CRSsNP in comparison to rhinitis patients without CRS and the general population.METHODS:A prospectively collected database of 334 consecutive CRS patients who had surgery after failing maximal medical therapy was queried to identify those who met inclusion criteria: a Sinus Computed Tomography(CT), an endoscopy consistent with CRS and skin-prick testing with 24 common inhalant allergens in 8 classes at our institution (n=125). Additionally, data from these CRS patients were compared to a group of 50 patients diagnosed with rhinitis who had similar symptoms but radiologically normal CT scans, as well as published normative population skin prick testing data obtained from the National Health and Nutrition Examination Study III (NHANES III). The relationship between atopy, as assessed by the frequency of skin test positivity, and radiological disease severity was assessed for several allergen classes in CRSwNP, CRSsNP and rhinitis patients.RESULTS:One or more positive skin results were observed in 103/125 (82.4%) CRS patients who underwent surgery- a prevalence significantly higher than that found in the NHANES III study (p<0.05) but not different from the rhinitis control group (36/50 -72.0 %). The most prevalent positive skin test results were to dust mites and ragweed in CRSwNP, CRSsNP and rhinitis patients. Comparing these three patient groups, there were no significant differences in the rates of positive skin test results to any single allergen. However, the median number of skin test positive results was higher in CRSwNP patients compared to CRSsNP and rhinitis patients. Consistent with other studies, we found that CRSwNP patients were more likely to be male and have concurrent asthma.CONCLUSIONS:In our series of patients failing medical therapy for CRS, we found higher rates of atopy compared with the general population but not compared with rhinitis patients. CRSwNP patients with medically refractory sinusitis were more likely to have multiple positive skin tests and asthma as compared to the general population or patients with either CRSsNP or rhinitis. Host barrier dysfunction may play a role in enabling multisensitization.