Atopy in chronic rhinosinusitis: impact on quality of life outcomes

Abstract

Background: Chronic rhinosinusitis (CRS), in particular with nasal polyps (CRSwNP), has been linked with skewed T-helper 2 and immunoglobulin E (IgE)-mediated allergic responses. The role of atopy in CRS, however, remains unclear. Correlations between immunological allergic markers and patient-reported outcomes measures (PROMs) were investigated. Methods:A cross-sectional study of adult patients with CRS undergoing endoscopic sinus surgery was conducted. Immunological allergic markers included automated immunoassay testing for serum-specific IgE to common allergens (house dust mite, grass, mold, animal epithelia) and total IgE. PROMs were assessed using the 22-item Sino-Nasal Outcome Test (SNOT-22). Patients were defined as atopic based on either a positive specific IgE or elevated total IgE (>160 kU/L). Results:A total of 446 patients (45.7% female, age 49.05 ± 14.96 years) were recruited, of which 42.8% had asthma, 51.6% had CRSwNP, and 63.0% had eosinophilic CRS. Positive allergen sensitization was detected in 52.9% patients. Total IgE levels were elevated in 28.0% with mean IgE level of 161 ± 269 kU/L. Atopy was associated with younger age at the time of surgery, CRSwNP, asthma, and eosinophilic CRS (eCRS). Atopy was also associated with increased severity in nasal symptom score (13.1 ± 6.4 vs 11.9 ± 6.0, p = 0.04), as well as worse scores in the loss of smell/taste (χ 2 (1) = 5.97, p = 0.02) and need to blow nose (χ 2 (1) = 4.26, p = 0.04) questions in the CRS population. In the CRSwNP population, there was no significant association between atopy and PROMs. Conclusion:Comorbid atopy in CRS is associated with additional symptom burden, reflected mainly within the nasal symptom quality of life markers. Atopy assessment in CRS is important to ensure appropriate and successful treatment of the disease. C 2018 ARS-AAOA, LLC.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…Other studies have found no significant association between CRSwNP and allergy. Study findings include similar rates of hypersensitivity between CRSwNP and CRSsNP groups; 1385 similar incidence of allergy and endotype profiles between CRSwNP and CRSsNP; 1386 no difference in symptoms among allergic and non‐allergic CRSwNP patients during pollen season 1387 no differences in nasal polyp size, CT scores, symptoms, or recurrence of disease between atopic and non‐atopic CRSwNP patients 1388 or difference in presenting symptoms or post‐operative course of CRSwNP patients based on allergic status 1389,1390 In contrast, 1 study found increased rates of atopy in CRSwNP patients, though no significant difference in symptoms scores 1391 …”

Central compartment atopic disease: prevalence of allergy and asthma compared with other subtypes of chronic rhinosinusitis with nasal polyps

“…Although asthma in AERD patients tends to segregate in the severe persistent category, patients with AERD can have mild or moderate persistent asthma or even intermittent asthma, which may be missed if not adequately assessed. Furthermore, comorbid AR and asthma may predict severity of disease and increased symptom burden . A recent prospective case‐control study demonstrated that CRSwNP with comorbid AR and asthma was associated with increased eosinophil ratios and a higher risk of polyp recurrence .…”

“…Furthermore, comorbid AR and asthma may predict severity of disease and increased symptom burden. 30 A recent prospective case-control study demonstrated that CRSwNP with comorbid AR and asthma was associated with increased eosinophil ratios and a higher risk of polyp recurrence. 31 Therefore, it is necessary to obtain a thorough allergy and asthma history when CRSwNP is identified.…”

Focusing on quality of life in chronic rhinosinusitis patients

“…Yet the effect of atopy on quality of life is ill‐defined. In the article by Ho et al., the authors performed a cross‐sectional study on CRS patients undergoing functional endoscopic sinus surgery and specifically assessed the impact of atopy on disease‐specific quality of life. Atopy was defined by either a positive test for allergen‐specific immunoglobulin E (IgE) or an elevation in total IgE, and quality of life metrics were assessed using the 22‐item Sino‐Nasal Outcome Test (SNOT‐22).…”