Evaluation and treatment of rhinosinusitis with primary antibody deficiency in adults: Evidence-based review with recommendations

Chadi A Makary; Amber U Luong; Antoine Azar; Jean Kim; Omar G Ahmed; Mohamad R Chaaban; Cecilia C Damask; Paavali Hannikainen; Stephanie Joe; Kent Lam; Brian P Peppers; Anju T Peters; Elina Toskala; Sandra Y Lin

doi:10.1002/alr.23206

Evaluation and treatment of rhinosinusitis with primary antibody deficiency in adults: Evidence-based review with recommendations

Int Forum Allergy Rhinol. 2023 Dec;13(12):2205-2230. doi: 10.1002/alr.23206. Epub 2023 Jun 26.

Authors

Chadi A Makary¹, Amber U Luong², Antoine Azar³, Jean Kim⁴, Omar G Ahmed⁵, Mohamad R Chaaban⁶, Cecilia C Damask⁷, Paavali Hannikainen⁸, Stephanie Joe⁹, Kent Lam¹⁰, Brian P Peppers¹¹, Anju T Peters¹², Elina Toskala¹³, Sandra Y Lin¹⁴

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA.
² Department of Otorhinolaryngology, McGovern, Medical School of the University of Texas Health Science at Houston, Houston, Texas, USA.
³ Division of Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁵ Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA.
⁶ Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio, USA.
⁷ Department of Otolaryngology, University of Central Florida, Lake Mary, Florida, USA.
⁸ Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
⁹ Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, Illinois, USA.
¹⁰ Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia, USA.
¹¹ Division of Adult and Pediatric Allergy and Immunology, Department of Pediatrics, West Virginia University, Morgantown, West Virginia, USA.
¹² Division of Allergy Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
¹³ Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
¹⁴ Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.

PMID: 37300852
DOI: 10.1002/alr.23206

Abstract

Background: There is clear evidence that the prevalence of primary antibody deficiency (PAD) is higher in patients with recurrent and chronic rhinosinusitis (CRS) than in the general population. The purpose of this multi-institutional and multidisciplinary evidence-based review with recommendations (EBRR) is to thoroughly review the literature on rhinosinusitis with PAD, summarize the existing evidence, and provide recommendations on the evaluation and management of rhinosinusitis in patients with PAD.

Methods: The PubMed, EMBASE, and Cochrane databases were systematically reviewed from inception through August 2022. Studies on the evaluation and management of rhinosinusitis in PAD patients were included. An iterative review process was utilized in accordance with EBRR guidelines. Levels of evidence and recommendations on the evaluation and management principles for PAD were generated.

Results: A total of 42 studies were included in this evidence-based review. These studies were evaluated on incidence of PAD in rhinosinusitis patients, incidence of rhinosinusitis in PAD patients, and on the different treatment modalities used and their outcome. The aggregate quality of evidence was varied across reviewed domains.

Conclusion: Based on the currently available evidence, PAD can occur in up to 50% of patients with recalcitrant CRS. Despite the presence of multiple studies addressing rhinosinusitis and PAD, the level of evidence supporting different treatment options continues to be lacking. Optimal management requires a multidisciplinary approach through collaboration with clinical immunology. There is need for higher-level studies that compare different treatments in patients with PAD and rhinosinusitis.

Keywords: antibody deficiency; chronic rhinosinusitis; evaluation; immunodeficiency disorders; recommendations; recurrent acute rhinosinusitis; treatment.

Publication types

Review

MeSH terms

Adult
Chronic Disease
Humans
Prevalence
Primary Immunodeficiency Diseases*
Rhinitis* / diagnosis
Rhinitis* / epidemiology
Rhinitis* / therapy
Sinusitis* / diagnosis
Sinusitis* / epidemiology
Sinusitis* / therapy