Central compartment atopic disease: prevalence of allergy and asthma compared with other subtypes of chronic rhinosinusitis with nasal polyps

Abstract

Background Central compartment atopic disease (CCAD) is a recently described variant of chronic rhinosinusitis with nasal polyp (CRSwNP) associated with inhalant allergy. An association with asthma was noted to be uncommon within our clinical practice. The purpose of this study was to determine allergy and asthma prevalence in CCAD and other CRSwNP subtypes. Methods A retrospective analysis at a tertiary care institution was performed over the period from 2015 to 2019. CRSwNP was grouped into the following subtypes: allergic fungal rhinosinusitis (AFRS); aspirin‐exacerbated respiratory disease (AERD); CCAD; and CRSwNP not otherwise specified (CRSwNP NOS). Patients with sinonasal polyps and concomitant polypoid disease in the central compartment (CRSwNP/CC) were analyzed as a separate cohort for the purpose of this study. Prevalence of allergy and asthma was compared between groups. Results Three hundred fifty‐six patients were included. CRSwNP NOS was the most common subtype (37.1%) and CRSwNP/CC was the least common (3.7%), with other CRS subtypes ranging between 11.5% and 24.2%. Asthma prevalence was highest in AERD (100%) and CRSwNP NOS (37.1%), but substantially lower in AFRS (19.0%) and CCAD (17.1%). Asthma was significantly more common in AERD and CRSwNP NOS when compared with CCAD (p < 0.001 and p = 0.039, respectively). Prevalence of allergy was significantly higher in AFRS (100%), CCAD (97.6%), CRSwNP/CC (84.6%), and AERD (82.6%) when compared with CRSwNP NOS (56.1%) (p < 0.001). Conclusion CCAD represents a clinically distinct phenotype of CRSwNP with a high prevalence of allergy and low prevalence of asthma. Patients with both CCAD and diffuse sinonasal polyps had an allergy prevalence approaching that of CCAD and an asthma prevalence approaching CRSwNP NOS.

Central compartment atopic disease: the missing link in the allergy and chronic rhinosinusitis with nasal polyps saga

“…This yielded an aggregate level of evidence grade D. A weakness of this review and the studies included is that CRSwNP is viewed as a single entity, despite the fact that there are multiple subtypes, such as allergic fungal rhinosinusitis (AFRS), aspirin‐exacerbated respiratory disease (AERD), and CRSwNP not otherwise specified (CRSwNP NoS). It is likely that these individual subtypes have different degrees of association with allergy 2 …”

Aspirin‐exacerbated respiratory disease: personalized medical and surgical approaches

“…10 Rhinologists have recognized that AERD patients have more opacification of the olfactory cleft and septum. 2,11,12 Reasons for this unique distribution of polyposis are unclear, but physical obstruction of odorants to the olfactory neuroepithelium almost certainly occurs. Interestingly, the Emory group (Emory University, Atlanta, GA) has described groups of patients with central compartment atopic disease (CCAD).…”

“…Although many patients with central compartment distribution have AERD, there are a subset of CCAD patients that do not report asthma or aspirin sensitivity. 2,11 Improved understanding of phenotypes and endotypes in CRS has dramatically expanded in the last several years, and this includes AERD. Although AERD is typically considered its own subset of CRSwNP, Kowalski et al 3 have suggested that there may be up to 4 different subphenotypes of AERD which differ in symptom severity and biomarkers including blood eosinophils, immunoglobulin E (IgE), urinary leukotrienes, and atopic status.…”

“…In examining patients presenting to tertiary practices, AERD may represent 10% of all patients with chronic rhinosinusitis (CRS) and asthma, 1 and this increases up to 28% of CRS with nasal polyposis (CR-SwNP) patients undergoing surgery at an academic rhinology practice. 2 Strict diagnostic criteria have been nicely described 3 ; however, in many practices these resources are limited. Delay in diagnosis has been associated with increased systemic steroid use, 4 thus additional clinical factors may alert the astute physician to the presence of AERD.…”

“…1,6 Reports have differed on the association of atopy with AERD, with some authors suggesting there is no increase compared to non-AERD patients, whereas others report atopy rates as high as 82% in AERD patients. 2,7 Two additional clinical factors that are of particular interest to rhinologists are the impact of AERD upon olfaction and the unique distribution of polyps on computed tomography (CT). AERD has a more severe impact upon olfaction that other forms of CRSwNP, and up to 100% of AERD patients have dysosmia.…”