Immune dysfunction in refractory sinusitis in a tertiary care setting

Objective: To examine the contribution of the primary immunodeficiency stat es, which are uncommon in the general population, to refractory sinusitis. Study Design: We retrospectively reviewed the charts of 316 patients with s inusitis who were referred to the Allergy and Immunology Clinic for immunol ogical 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 im munodeficiency virus (HIV), allergic fungal sinusitis, cystic fibrosis, and primary ciliary dyskinesia were excluded. The results of their immunologic al evaluation for atopy, T-lymphocyte function, and immunoglobulin levels w ere examined. Results: The average age of these 79 patients was 44 years (/- 14.5 standard deviation [SDI]). 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 reveale d that 22 of 55 patients (40%) were anergic. Of the 60 patients with in vit ro T-lymphocyte function testing, 54.8% showed abnormal proliferation in re sponse 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 patie nts (17.9%), low immunoglobulin A in 13 of 78 (16.7%), and low immunoglobul in M in 4 of 78 (5.1%). Common variable immunodeficiency (CVID) was diagnos ed in 9.9% of patients, and selective IgA deficiency was found in 6.2%. Con clusions: This retrospective review reveals an unexpectedly high incidence of immune dysfunction. These results suggest that immunological testing sho uld be an integral part of the evaluation of patients with refractory sinus itis.