Immunoglobulin deficiency in patients with chronic rhinosinusitis: Systematic review of the literature and meta-analysis.
BACKGROUND
Several studies have shown a high prevalence of immunoglobulin deficiencies in patients with chronic rhinosinusitis (CRS).


OBJECTIVE
We sought to perform a systematic review and meta-analysis to estimate this prevalence more precisely and to identify patients who need substitution treatment.


METHODS
All case series published after 1990 describing patients with CRS, which was defined as symptomatic rhinosinusitis for more than 12 weeks and documented immunoglobulin deficiencies (including deficiencies of IgG with subclasses, IgA, and IgM; specific antibody deficiencies; and potential common variable immunodeficiency), were retrieved. A meta-analysis of the proportion of any combination of common variable immunodeficiency, IgG deficiency, IgA deficiency, and IgM deficiency in patients with CRS was performed by using logit transformation of the prevalence. Recurrent CRS was defined as rhinosinusitis not controlled by appropriate conservative management for 4 months, and difficult-to-treat CRS was defined as noncontrollable rhinosinusitis despite successful sinus surgery and appropriate conservative management for at least 1 year.


RESULTS
The meta-analysis revealed a prevalence of pooled IgG, IgA, and IgM deficiencies in 13% of patients with recurrent CRS and 23% of patients with difficult-to-treat CRS. The prevalence of IgG subclass deficiency (5% to 50%) and specific antibody deficiency (8% to 34%) was increased in patients with CRS, as was the prevalence of respiratory allergies in patients with recurrent CRS (31% to 72%).


CONCLUSIONS
Immunoglobulin deficiency is a frequent condition in patients with CRS. An even higher prevalence of atopy was observed in patients with recurrent CRS. Therefore immunoglobulin titers and accurate allergy diagnostic workups are strongly recommended in these patients to provide specific treatments for symptom alleviation. However, there is a need for larger prospective studies addressing the effect of specific therapeutic interventions for CRS.
Division of Immunology and Allergy, Department of Medical Specialties, University Hospitals and Medical Faculty, Geneva, Switzerland. Electronic address: Adrien.schwitzguebel@latour.ch.
Adrien J-P
AJ
Schwitzguébel
Division of Immunology and Allergy, Department of Medical Specialties, University Hospitals and Medical Faculty, Geneva, Switzerland.
Peter
P
Jandus
Department of Neurosciences, University of Geneva Medical School, Geneva, Switzerland.
Jean-Silvain
JS
Lacroix
Division of Immunology and Allergy, Department of Medical Specialties, University Hospitals and Medical Faculty, Geneva, Switzerland.
Jörg D
JD
Seebach
Division of Immunology and Allergy, Department of Medical Specialties, University Hospitals and Medical Faculty, Geneva, Switzerland. Electronic address: thomas.harr@hcuge.ch.
Thomas
T
Harr
D002908:Chronic Disease; D015897:Comorbidity; D004406:Dysgammaglobulinemia / Q000453:epidemiology*; D006801:Humans; D015995:Prevalence; D012220:Rhinitis / Q000453:epidemiology*; D012852:Sinusitis / Q000453:epidemiology*
IgG deficiency; Sinusitis; chronic; common variable immunodeficiency; hypersensitivity; immune deficiency syndromes; immunoglobulins; recurrence; respiratory tract infections; rhinitis