Acquired angioedema associated with sinusitis

Acute and chronic sinusitis are major clinical problems faced by physicians in several disciplines. Although there is a much studied relationship betw een sinusitis and asthma, as well as a well-known association of sinusitis and Wegener's granulomatosis, there is scant evidence suggesting an associa tion of angioedema with sinusitis. Angioedema can be extremely disfiguring, and is potentially lethal due to compromised airways. It is also a frustra ting diagnostic dilemma for patients and physicians. A diagnosis is found i n fewer than 25% of chronic urticaria patients and much less for angioedema . In this study, we report the cases of nine patients who were treated for chronic sinusitis, but who were referred for episodes of angioedema. Patien ts with a known diagnosis, such as the hereditary form, or drug or food all ergies, were excluded. Based on clinical suspicion or CT scan results, nine patients were treated for chronic sinusitis. Only three had symptoms sugge sting a sinus infection at presentation. After sinusitis treatment, all nin e patients had a marked improvement in their angioedema. None had further s evere angioedema episodes. Some patients continued to have mild episodes of angioedema, which they related to recurrence of sinusitis symptoms, and wh ich responded to antibiotics. The nine angioedema patients in this series a ll had strong evidence of sinusitis, albeit, most patients had occult disea se identified by CT scan. The dramatic improvement in angioedema with sinus itis treatment corroborates a causal relationship. Such findings encourage the investigation of sinusitis in these otherwise idiopathic patients. Sinu sitis evaluation may also be indicated for urticaria.