Outcome of Immunoglobulin Replacement Therapy in Adults With Rhinosinusitis

Abstract

Objective: To evaluate the outcome of immunoglobulin (IG) replacement therapy in adults with rhinosinusitis and primary humoral immunodeficiency disorders (PID).Study Design: Retrospective cohort study. Methods: Retrospective chart review of adult (18 years and older) patients who were diagnosed with PID and had the diagnosis of recurrent acute rhinosinusitis (RARS) and chronic rhinosinusitis (CRS) and who are on IG replacement therapy. Demographic data, associated conditions, and duration of treatment were reviewed. Number of yearly sinus infections, sinus CT Lund-Mackay (LM) score, and need for functional endoscopic sinus surgery (FESS) were reviewed before and after starting IG therapy.Results: Fifty-eight patients were included. Average age was 52 years (18-79 years). About 74% were female. Thirty patients (51.7%) had common variable immunodeficiency (CVID), 18 (31.1%) had hypogammaglobulinemia, and 10 (17.2%) had specific antibody deficiency (SAD). About 79% of patients had allergic rhinitis and 74% had asthma. Pretreatment LM score was 7.6 (AE2.2, range of 0-24) compared to posttreatment score of 3.5 (AE1.3, range of 0-16) (P = .01). Eleven patients (19%) had FESS pretreatment compared to only two patients (3.4%) requiring ESS after starting treatment on IG therapy (P = .004). Prior to starting IG therapy, five patients (8.6%) had more than 10 sinus infections per year, 33 patients (56.9%) had 5 to 10 infections, and 20 patients (34.5%) had 1 to 5 infections per year. After starting on IG, 34 patients (58.6%) had no infections reported anymore (P < .001), and 24 patients (41.4%) had only 1 to 5 infections reported per year Conclusion: IG therapy is a promising treatment option for recurrent rhinosinusitis in patients with PID.

Outcome of immunoglobulin replacement therapy in children with rhinosinusitis

“…Data on the role of immunoglobin replacement therapy in children with sinus disease is still limited and is an important area of further research. 1 Several studies 8,9 showed that immunoglobin therapy is beneficial in adults.…”

“…Data on the role of immunoglobin replacement therapy in children with sinus disease is still limited and is an important area of further research 1 . Several studies 8,9 showed that immunoglobin therapy is beneficial in adults. Other studies, such as the European study by Quinti et al, 3 showed that only 8% of patients with CVID who had CRS had improvement in their symptoms while on intravenous immunoglobin therapy.…”

“…Each patient had at least 6 months of follow‐up since starting treatment. Immunologic workup was standardized 9 and involved CBC with differential, serum levels of IgG, IgM, and IgA; IgG subclasses; and pneumococcal antibodies for 14 serotypes or 23 serotypes at baseline and 4 to 8 weeks after immunization. Diagnosis of CVID, specific antibody deficiency (SAD), and hypogammaglobulinemia were made based on published diagnostic criteria 5 …”

“…We recently showed that adult patients experienced subjective and objective improvement in the number of sinus infections after initiation of immunoglobin replacement therapy. 9 The goal of this study was to evaluate the outcome of immunoglobin replacement therapy in pediatric patients with rhinosinusitis and humoral deficiencies.…”

“…A recent meta‐analysis performed by Samargandy et al 6 in 2020 identified only two studies 7,8 that looked at the outcome of immunoglobin replacement therapy in adults with CRS. We recently showed that adult patients experienced subjective and objective improvement in the number of sinus infections after initiation of immunoglobin replacement therapy 9 . The goal of this study was to evaluate the outcome of immunoglobin replacement therapy in pediatric patients with rhinosinusitis and humoral deficiencies.…”