AAAAI, ACAAI identify new recommendations for sinusitis diagnosis

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Public release date: 29-Nov-2005

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American Academy of Allergy, Asthma & Immunology

http://www.eurekalert.org/pub_releases/2005-11/aaoa-aai112905.php

AAAAI, ACAAI identify new recommendations for sinusitis diagnosis

and management

From the Journal of Allergy & Clinical Immunology

Sinusitis is one of the most diagnosed diseases in the United

States, affecting approximately 16% of the adult population, and is

responsible for nearly $5.8 billion in health care costs annually,

according to an updated practice parameter. The Diagnosis and

Management of Sinusitis: A Practice Parameter Update is featured in

the December 2005 issue of the Journal of Allergy & Clinical

Immunology (JACI) and is currently available on the JACI's Web site

at www.jacionline.org. The JACI is the peer-reviewed, scientific

journal of the American Academy of Allergy, Asthma & Immunology

(AAAAI).

The practice parameter provides an updated definition of sinusitis

and new recommendations for the diagnosis and management of

sinusitis, including predisposing factors, antibiotic use, when to

see a specialist, and other diseases associated with sinusitis.

" This practice parameter is intended to improve on the diagnosis and

management of patients, " said G. Slavin, MD, MS, FAAAAI, and

lead author of the updated practice parameter. " This will result in

reduced health care costs, and a better quality of life for patients

with sinusitis. "

Sinusitis is an inflammation of one or more of the paranasal

sinuses, and can be divided into acute, subacute, chronic and

recurrent. The classifications are based on how long symptoms last,

the specific sinus involved, or both. The updated classification is

as follows:

Acute sinusitis: symptoms for less than 4 weeks consisting of some

or all of the following: persistent symptoms of an upper respiratory

tract infection, purulent rhinorrhea, postnasal drainage, anosmia,

nasal congestion, facial pain, headache, fever, cough, and purulent

discharge.

Subacute sinusitis: symptoms from four to eight weeks.

Chronic sinusitis: symptoms for eight weeks or longer of varying

severity consisting of the same symptoms as seen in acute sinusitis.

In chronic sinusitis there should be abnormal findings on CT or MRI.

Some patients with chronic sinusitis might present with vague or

insidious symptoms.

Recurrent sinusitis: three or more episodes of acute sinusitis per

year. Patients with recurrent sinusitis might be infected by

different organisms at different times.

The two most common predisposing conditions to developing sinusitis

are viral upper respiratory tract infections and allergic rhinitis.

Allergic rhinitis is one of the most common chronic diseases,

affecting up to 35.9 million Americans annually.

The diagnosis of sinusitis is based on a combination of clinical

history, physical examination, imaging studies, and/or laboratory

tests. The Diagnosis and Management of Sinusitis: A Practice

Parameter Update recommends:

The diagnosis of acute sinusitis should be primarily based on the

history and physical examination of the patient. Imaging techniques

such as radiographs or CT scans are not necessary.

Antibiotics should be withheld for 10 to 14 days, unless severe

symptoms develop such as fever, facial pain or tenderness, or

swelling around the eye.

The primary therapy for acute bacterial sinusitis is antibiotics,

but with increasing resistance to penicillin being reported,

alternative antibiotics may be necessary.

Referral to an allergist/immunologist, particularly for patients

with chronic or recurrent sinusitis associated with certain

conditions, and in patients who have undergone prior surgical

procedures and continue to experience sinusitis.

Surgery is a consideration only after medical therapy has failed.

According to the practice parameter and the AAAAI, referral to an

allergist/immunologist should be sought when:

The patient suffers chronic, recurrent infectious or fungal

rhinosinusitis.

There is a need to clarify whether an allergic or immune deficiency

condition is playing a role.

If the sinusitis does not respond to the usual antibiotic treatment.

If the sinusitis significantly affects performance and quality of

life.

The sinusitis co-exists with allergic rhinitis.

Working with an allergist/immunologist, the best qualified medical

professional trained to manage the prevention, diagnosis and

treatment of sinusitis and other allergic diseases, will demonstrate

improved outcomes and quality of life for people suffering from

allergic disease.

###

To find an allergist/immunologist in your area or to learn more

about sinusitis, call the AAAAI Physician Referral and Information

Line at (800) 822-2762 or visit the AAAAI Web site at www.aaaai.org.

The Diagnosis and Management of Sinusitis: A Practice Parameter

Update was developed by the Joint Task Force on Practice Parameters

for Allergy & Immunology, a joint coalition of the American Academy

of Allergy, Asthma & Immunology (AAAAI), the American College of

Allergy, Asthma & Immunology's (ACAAI), and the Joint Council of

Allergy, Asthma and Immunology (JCAAI). The AAAAI is the largest

professional medical specialty organization in the United States

representing allergists, asthma specialists, clinical immunologists,

allied health professionals and others with a special interest in

the research and treatment of allergic disease. Allergy/immunology

specialists are pediatric or internal medicine physicians who have

elected an additional two years of training to become specialized in

the treatment of asthma, allergy and immunologic disease.

Established in 1943, the AAAAI has more than 6,000 members in the

United States, Canada and 60 other countries. The AAAAI serves as an

advocate to the public by providing educational information through

its Web site at www.aaaai.org.