Immunoglobulin subclass deficiency in patients with chronic rhinosinusitis

In the present study 220 patients suffering from recurrent rhinosinusitis a nd not responding to antibiotic treatment were evaluated for a defect in Ig G-immunoglobulin subclasses. Twenty-one of these patients were found to hav e an antibody deficiency. These included deficiencies of lgG-2 (n=10), lgG- 1 (n=6), IgG-3 (n=1) and lgG-4 (n=1). A common variable immune disease was diagnosed in three patients that was characterized by an additional defect in the IgG main class. However,an IgG subclass deficiency can only be ascer tained by an immunological evaluation. The significance of a deficiency can be identified by a reaction to vaccination using (for example) protein or polysaccharide antigens. Treatment consists of anti biotics, intravenous im munoglobulins and long-term follow-up. Endonasal microsurgery should only b e performed in cases that do not respond to conservative treatment. lt is p articularly necessary to observe these patients because a deficiency of imm unoglobulin subclass in certain cases is the first sign of an immunological impairment that can advance to a severe immunodeficiency and predispose to the development of malignancy.