Get access

Immune Dysfunction in Refractory Sinusitis in a Tertiary Care Setting

Authors

  • Lincoln Chee MD,

    1. Department of Otolaryngology—Head and Neck Surgery, Iowa City, Iowa
    2. Division of Allergy and Immunology, Iowa City, Iowa
    Search for more papers by this author
  • Scott M. Graham MD,

    Corresponding author
    1. Department of Otolaryngology—Head and Neck Surgery, Iowa City, Iowa
    • Scott M. Graham, MD, University of Iowa Hospitals and Clinics, Department of Otolaryngology—Head and Neck Surgery, 200 Hawkins Drive, E230 GH, Iowa City, IA 52242, U.S.A.
    Search for more papers by this author
  • Daniel G. Carothers MD,

    1. Department of Otolaryngology—Head and Neck Surgery, Iowa City, Iowa
    Search for more papers by this author
  • Zuhair K. Ballas MD

    1. Division of Allergy and Immunology, Iowa City, Iowa
    2. Department of Internal Medicine, University of Iowa, and Department of Internal Medicine, Iowa City, Iowa
    3. Veterans' Administration Medical Center, Iowa City, Iowa
    Search for more papers by this author

Abstract

Objective To examine the contribution of the primary immunodeficiency states, which are uncommon in the general population, to refractory sinusitis.

Study Design We retrospectively reviewed the charts of 316 patients with sinusitis who were referred to the Allergy and Immunology Clinic for immunological evaluation from 1991 to 1997.

Methods Of the 316 patients, 79 were selected for further study. Inclusion criteria included at least one sinus surgery and/or sinusitis diagnosed by endoscopy and/or computed tomography (CT) scan at least three times in the previous year. Patients with human immunodeficiency virus (HIV), allergic fungal sinusitis, cystic fibrosis, and primary ciliary dyskinesia were excluded. The results of their immunological evaluation for atopy, T-lymphocyte function, and immunoglobulin levels were examined.

Results The average age of these 79 patients was 44 years (± 14.5 standard deviation [SD]). They had, on average, 2.94 (± 2.19 SD) previous operations and had mean sinus CT scores (Lund-McKay) of 11.2 (± 5.0 SD). Forty of 79 (50.6%) patients had at least one positive result on skin test to an aeroallergen. Delayed hypersensitivity skin testing revealed that 22 of 55 patients (40%) were anergic. Of the 60 patients with in vitro T-lymphocyte function testing, 54.8% showed abnormal proliferation in response to recall antigens, 11.3% had decreased response to alloantigen, and 26.3% demonstrated decreased response to T-cell mitogens. Determination of quantitative immunoglobulins showed low immunoglobulin G in 14 of 78 patients (17.9%), low immunoglobulin A in 13 of 78 (16.7%), and low immunoglobulin M in 4 of 78 (5.1%). Common variable immunodeficiency (CVID) was diagnosed in 9.9% of patients, and selective IgA deficiency was found in 6.2%.

Conclusions This retrospective review reveals an unexpectedly high incidence of immune dysfunction. These results suggest that immunological testing should be an integral part of the evaluation of patients with refractory sinusitis.

Ancillary