Clinical Characteristics of Patients with Chronic Rhinosinusitis and Specific Antibody Deficiency

Abstract

RationaleSpecific antibody deficiency (SAD) is characterized by an inadequate polysaccharide vaccine response and is considered in patients with chronic rhinosinusitis (CRS). There is limited data on patients with CRS and SAD. We assessed the clinical characteristics, comorbidities and outcomes of these patients.MethodsWe reviewed the electronic database records of patients with CRS who were evaluated for immunodeficiency with quantitative immunoglobulins or pneumococcal antibody titers checked pre- and post-Pneumovax® between 2002 and 2011. The subjects’ clinical and laboratory results were assessed.ResultsOf 528 subjects with CRS, 149 (28%) had CRS with nasal polyps (CRSwNP) and 379 (72%) had CRS without nasal polyps (CRSsNP). Of the 247 subjects evaluated for SAD, 50 (20%) had an inadequate response to the vaccine (10 of 68 [15%] in the CRSsNP group and 40 of 179 [22%] in the CRSwNP group). Nonresponders had significantly lower IgG levels, although within normal range (>700 mg/dL), compared with responder and normal baseline subjects (874.0±308.2 vs. 956.7±212.4 vs. 1022.5±281.0, p<0.01). Nonresponders received more antibiotics courses relative to responders in the two years following Pneumovax® (3.12±2.52 vs. 2.30±2.42, p<0.05). CRSsNP asthmatics had significantly lower post-immunization titers compared to CRSsNP non-asthmatics (9.17±3.28 vs. 7.49±3.585, p<0.05). Eleven nonresponders (22%) received immunoglobulin (Ig) replacement therapy.ConclusionsOf 247 CRS patients evaluated for immunodeficiency, 20% had SAD. On average, those with SAD received more courses of antibiotics than those without. Eleven patients with SAD (22%) received Ig therapy over an eight-year time period, suggesting that a majority of these patients do not need Ig therapy. RationaleSpecific antibody deficiency (SAD) is characterized by an inadequate polysaccharide vaccine response and is considered in patients with chronic rhinosinusitis (CRS). There is limited data on patients with CRS and SAD. We assessed the clinical characteristics, comorbidities and outcomes of these patients. Specific antibody deficiency (SAD) is characterized by an inadequate polysaccharide vaccine response and is considered in patients with chronic rhinosinusitis (CRS). There is limited data on patients with CRS and SAD. We assessed the clinical characteristics, comorbidities and outcomes of these patients. MethodsWe reviewed the electronic database records of patients with CRS who were evaluated for immunodeficiency with quantitative immunoglobulins or pneumococcal antibody titers checked pre- and post-Pneumovax® between 2002 and 2011. The subjects’ clinical and laboratory results were assessed. We reviewed the electronic database records of patients with CRS who were evaluated for immunodeficiency with quantitative immunoglobulins or pneumococcal antibody titers checked pre- and post-Pneumovax® between 2002 and 2011. The subjects’ clinical and laboratory results were assessed. ResultsOf 528 subjects with CRS, 149 (28%) had CRS with nasal polyps (CRSwNP) and 379 (72%) had CRS without nasal polyps (CRSsNP). Of the 247 subjects evaluated for SAD, 50 (20%) had an inadequate response to the vaccine (10 of 68 [15%] in the CRSsNP group and 40 of 179 [22%] in the CRSwNP group). Nonresponders had significantly lower IgG levels, although within normal range (>700 mg/dL), compared with responder and normal baseline subjects (874.0±308.2 vs. 956.7±212.4 vs. 1022.5±281.0, p<0.01). Nonresponders received more antibiotics courses relative to responders in the two years following Pneumovax® (3.12±2.52 vs. 2.30±2.42, p<0.05). CRSsNP asthmatics had significantly lower post-immunization titers compared to CRSsNP non-asthmatics (9.17±3.28 vs. 7.49±3.585, p<0.05). Eleven nonresponders (22%) received immunoglobulin (Ig) replacement therapy. Of 528 subjects with CRS, 149 (28%) had CRS with nasal polyps (CRSwNP) and 379 (72%) had CRS without nasal polyps (CRSsNP). Of the 247 subjects evaluated for SAD, 50 (20%) had an inadequate response to the vaccine (10 of 68 [15%] in the CRSsNP group and 40 of 179 [22%] in the CRSwNP group). Nonresponders had significantly lower IgG levels, although within normal range (>700 mg/dL), compared with responder and normal baseline subjects (874.0±308.2 vs. 956.7±212.4 vs. 1022.5±281.0, p<0.01). Nonresponders received more antibiotics courses relative to responders in the two years following Pneumovax® (3.12±2.52 vs. 2.30±2.42, p<0.05). CRSsNP asthmatics had significantly lower post-immunization titers compared to CRSsNP non-asthmatics (9.17±3.28 vs. 7.49±3.585, p<0.05). Eleven nonresponders (22%) received immunoglobulin (Ig) replacement therapy. ConclusionsOf 247 CRS patients evaluated for immunodeficiency, 20% had SAD. On average, those with SAD received more courses of antibiotics than those without. Eleven patients with SAD (22%) received Ig therapy over an eight-year time period, suggesting that a majority of these patients do not need Ig therapy. Of 247 CRS patients evaluated for immunodeficiency, 20% had SAD. On average, those with SAD received more courses of antibiotics than those without. Eleven patients with SAD (22%) received Ig therapy over an eight-year time period, suggesting that a majority of these patients do not need Ig therapy.