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

Abstract

Central compartment atopic disease the missing link in the allergy and chronic rhinosinusitis with nasal polyps saga There has been a long-standing debate on the relationship between allergy and chronic rhinosinusitis (CRS). Multiple studies have been published with mixed results for both CRS without nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP). In an evidence-based review of the relationship between CRS and allergy, Wilson et al. 1 found no consistent association between allergy and CRSsNP and CRSwNP. For CRSwNP, 10 articles showed an association whereas 7 showed no association, with 1 being equivocal. This yielded an aggregate level of evidence grade D. A weakness of this review and the studies included is that CR-SwNP 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 Some clarity to the issue of whether or not there is a relationship between allergy and CRSwNP has been provided in recent years. Our group first reported a clear association between allergy and nasal polyps in 2014, with 16 of 16 patients with isolated middle turbinate polyps or polypoid edema having positive allergy testing. 3 In 2016, Hamizan et al., 4 in a retrospective review, found a strong association between middle turbinate edema/polyps and allergy. Brunner et al. 5 reported that patients with isolated middle turbinate polyps are a distinct group compared to patients with diffuse sinonasal polyps, with younger age (35 vs 53 years), less CRS (10% vs 100%), lower Lund-Mackay scores, and significantly more allergy (83% vs 34%), respectively. In 2017 we first described central compartment atopic disease (CCAD), a nasal inflammatory subtype of CRSwNP that involves polypoid changes of the central compartment of the nasal cavity, which includes the posterosuperior nasal septum, middle turbinate, and/or superior turbinate. 6 In this series, 15 patients with central compartment polyps were positive on allergy testing. The disease process, similar to middle turbinate polyps, only involves the sinuses secondarily by lateralization or polypoid changes of the middle turbinates causing secondary obstruction of the sinuses. This tends to be absent in early CCAD but more

The Role of Allergen-Specific Immunotherapy in ENT Diseases: A Systematic Review

“…CCAD is a nasal inflammatory subtype of type 2 diffuse CRS characterized by polypoid degeneration of the central compartment of the nasal cavity, which includes either the postero-superior nasal septum, the middle turbinate, the superior turbinate, or in combination [ 60 , 83 ]. Overall, this central pattern of inflammatory changes is associated with 97.6% of prevalence of clinical AR [ 84 ].…”

Clinical characteristics and cytokine profiles of central‐compartment‐type chronic rhinosinusitis

“…The presence of total opacifications of the bilateral maxillary sinuses excluded the subjects from the diagnosis of central compartment type CRS. With advanced stages of CRS, it is more difficult to radiologically distinguish central‐compartment‐type CRS from others 5 . Therefore, patients who had previously undergone sinus surgery and pansinusitis (the Lund‐Mackay scores >23) were also excluded.…”

“…Central compartment atopic disease (CCAD), defined as the inflammation and edema of the central sinonasal compartment, is a phenotypic subtype of CRS first described in 2017, and it was reported to be associated with inhalant allergen sensitization 1–5 . The diagnosis of CCAD can be made endoscopically and/or radiographically 2,4,6 .…”

Chinese Central Compartment Atopic Disease: The Clinical Characteristics and Cellular Endotypes Based on Whole-Slide Imaging

“…Previous reports have showed that the MT and NS were the most frequent sites where allergens deposited. 3 , 4 The prevalence of allergy was higher (97.6%) while the prevalence of asthma was lower (17.1%) in CCAD patients than other CRSwNP subtypes. 5 …”

“… 2 CCAD is also defined as an inflammatory process that results from inhalant allergy, which provides a definitive link between allergy and CRSwNP. 3 The involvement of the central compartment area may be due to the deposition of allergen. Previous reports have showed that the MT and NS were the most frequent sites where allergens deposited.…”