Primary Immunodeficiency Doubles Chronic Rhinosinusitis Risk, But Not Its Severity: Study Reveals

"Despite the increased prevalence of CRS, these patients did not experience more frequent episodes of acute rhinosinusitis, did not require additional antibiotics, and did not have a higher likelihood of needing functional endoscopic sinus surgery," the researchers reported in the American Journal of Otolaryngology.

Sinusitis is a major global health issue, affecting about 31 million adults in the U.S. alone. Symptoms include nasal drainage, obstruction, facial pain, and reduced smell. Sinusitis is classified by duration: acute rhinosinusitis (less than 4 weeks), subacute (4–12 weeks), and chronic rhinosinusitis (over 12 weeks). Treatment focuses on managing inflammation and infection, with antibiotics, saline rinses, and steroid sprays. Immunodeficiencies like IgA, IgG, and specific antibody deficiency (SAD) are linked to chronic CRS, though their impact on severity remains unclear.

To fill this knowledge gap, Christopher D. Brook, Department of Otolaryngology-Head & Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA, and colleagues aimed to evaluate the impact of primary IgA and/or IgG immunodeficiency on the severity of chronic rhinosinusitis.

For this purpose, the researchers reviewed adult patients at Beth Israel Deaconess Medical Center in Boston with IgA and/or IgG deficiency (group A) or normal IgA and IgG levels (group B) between 2016 and 2022. Patients with other immunodeficiencies were excluded. The two groups were compared for CRS prevalence using ICD-10 codes and matched for demographics and comorbidities. They analyzed the number of acute rhinosinusitis (ARS) episodes, average lifetime ARS episodes, and ARS episodes per year, with or without antibiotic treatment. Additional analyses focused on the need for functional endoscopic sinus surgery (FESS) and the number of FESS procedures, based on CPT codes.

The study revealed the following findings:

• Three-hundred forty-six patients had IgA and/or IgG deficiency (group A), while 11,438 patients had normal IgA and IgG levels (group B).
• The prevalence of CRS was higher in group A compared to group B (12% versus 5%).
• Group A had a greater number of patients with three or more ARS episodes, higher mean lifetime ARS episodes, and more ARS episodes per year, although these differences were not statistically significant.
• There was no difference between the groups in the need for functional endoscopic sinus surgery or the average number of lifetime FESS procedures.

"Our study shows that while CRS prevalence is higher in patients with IgA and/or IgG deficiency, these immunodeficiencies do not necessarily increase the risk of ARS episodes or predict the need for FESS," the researchers wrote.

"Further research with larger, prospective patient cohorts is needed to better understand the mechanisms linking primary immunodeficiencies to CRS and to inform targeted treatment approaches," they concluded.

Reference:

Tie, K., Aboueisha, M. A., Wang, M., Caradonna, D. S., & Brook, C. D. (2024). The impact of primary immunodeficiency on the severity of chronic rhinosinusitis. American Journal of Otolaryngology, 46(1), 104541. https://doi.org/10.1016/j.amjoto.2024.104541