title: Sinonasal anatomic variants and asthma are associated with faster development of chronic rhinosinusitis in patients with allergic rhinitis.
abstract: BACKGROUND
  Allergic rhinitis (AR) and chronic rhinosinusitis (CRS) are a major burden to the healthcare system. Although no causal relationship has been established, previous work has demonstrated a strong association of AR with CRS. In this study, we sought to identify risk factors that may influence speed of development of CRS in patients with AR.
  
  
  METHODS
  Retrospective review of all patients diagnosed with AR without CRS presenting to an otolaryngology clinic at a tertiary medical center as part of a multidisciplinary allergy evaluation between March 2004 and November 2011. Medical records were evaluated for clinicodemographic factors including age, gender, smoking history, medical comorbidities, categories of AR based on formal allergy testing, the presence of sinonasal anatomic variants on computed tomography as well as subsequent development of CRS.
  
  
  RESULTS
  Faster progression to CRS in patients with AR was associated with comorbid asthma (hazard ratio [HR] = 3.97) as well as sinonasal anatomic variants, such as infraorbital cells (HR = 7.39), and frontal intersinus cells (HR = 68.03), on multivariate survival analysis. A statistically significant but negative interaction between infraorbital cells and frontal intersinus cells suggests that concomitant presence of both leads to a less than additive increase in the rate of CRS progression.
  
  
  CONCLUSIONS
  Sinonasal anatomical variants, infraorbital cells, and frontal intersinus cells, as well as comorbid asthma are associated with faster development of CRS in patients with AR. The presence of these clinical risk factors identifies patients who should be counseled on compliance with medical therapy for AR.
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA; Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA.
authors.forename: Ahmad R
authors.initials: AR
authors.lastname: Sedaghat
authors.forename: Stacey T
authors.initials: ST
authors.lastname: Gray
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Chambers
authors.forename: Claus O
authors.initials: CO
authors.lastname: Wilke
authors.forename: David S
authors.initials: DS
authors.lastname: Caradonna
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000453:epidemiology*; D002908:Chronic Disease; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000033:anatomy & histology*; D012189:Retrospective Studies; D012220:Rhinitis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D012221:Rhinitis, Allergic, Perennial / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D006255:Rhinitis, Allergic, Seasonal / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D012307:Risk Factors; D012852:Sinusitis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis
keywords: Haller cell; allergic rhinitis; asthma; chronic rhinosinusitis; computed tomography; frontal intersinus cell; infraorbital cell