Prevalence of allergy in patients with chronic rhinosinusitis

OBJECTIVES

The purpose of this study was to provide further evidence that allergic rhinitis is an important factor in chronic and recurrent acute rhinosinusitis. Specifically, this study shows that perennial allergens play a more significant role than seasonal allergens.

STUDY DESIGN AND SETTING

Census by chart review of patients with chronic and recurrent acute rhinosinusitis presenting to the Department of Otolaryngology at the MetroHealth Medical Center, Cleveland, OH.

METHODS

All participants had allergy testing done either by RAST or intradermal skin endpoint titration utilizing a battery of seasonal and perennial antigens.

RESULTS

Of the 48 voluntary participants analyzed in this study, 57.4% had a positive allergy test. Most patients in the study were sensitive to more than one allergen. Of the patients with a positive allergy test, 92% demonstrated sensitivity to one or more perennial allergens-most prominently, molds and dust mites.

CONCLUSIONS

Perennial allergy has a statistically significant association with chronic and recurrent acute rhinosinusitis.

SIGNIFICANCE

The diagnosis and management of perennial allergies may be beneficial when treating chronic sinus disease.

Malbranchea pulchella fungal sinusitis

Fungal sinus disease is being reported with increasing frequency. We could find no previously reported cases of sinonasal infections with Malbranchea pulchella and only two previously reported cases of human infection of any kind. We now report on a case of suspected sinonasal Malbranchea pulchella in a patient with aspirin-sensitive triad asthma.

Fungal diseases of the sinuses

With recent advances in medicine, fungal diseases are becoming not only better understood, but also increasingly important in the management of patients with paranasal sinus disease. Fungal sinus diseases run the gamut from allergic fungal rhinitis and allergic fungal sinusitis, through fungus balls, to invasive and fulminant fungal sinusitis. Allergic fungal sinusitis may be thought of as the sinus counterpart of allergic bronchopulmonary fungal disease. Patients typically are first seen with chronic sinusitis. They may be atopic, and the peripheral blood often shows elevated IgE levels and absolute eosinophil counts. Such patients may be managed conservatively, requiring only surgical drainage and corticosteroid therapy. Fungus balls are typified by the so-called "aspergilloma." Although patients often have some predisposing factor, such as local tissue hypoxia or massive fungal exposure, most patients are not immunocompromised. Fungus balls may be treated with the traditional Caldwell-Luc operation or with newer endoscopic procedures. Invasive or fulminant fungal sinusitis generally occurs in immunosuppressed patients and merits aggressive surgical excision and debridement, as well as systemic chemotherapy, usually amphotericin B. In this article, we review fungal disease of the paranasal sinuses and present findings from our review of patients with chronic sinusitis.