Predictive Value of Radiologic Central Compartment Atopic Disease for Identifying Allergy and Asthma in Pediatric Patients

Abstract

Introduction: Central compartment atopic disease (CCAD) has recently been suggested as a phenotype of chronic rhinosinusitis (CRS). This study aims to investigate the prevalence of the radiologic CCAD phenotype in CRS within a pediatric population and identify its ability to predict comorbid allergy and asthma. Methods: Computed tomography and endoscopic examination were conducted on pediatric patients with CRS either with or without nasal polyps. Allergen sensitization was determined with the multiple-allergen simultaneous test and skin prick test. Serum total immunoglobulin E (IgE), peripheral blood eosinophil percentage, and presence of asthma were also evaluated. Results: A total of 82 pediatric patients were enrolled. Overall, 55 (67.1%) of the participants demonstrated aeroallergen sensitization, and 31 (18.9%) of the 164 sides of sinuses were radiologically defined to fit the CCAD phenotype. Patients having CRS with the CCAD phenotype had a higher prevalence of aeroallergen sensitization (87.1% vs 62.4%, P = .008), particularly house dust mite (74.2% vs 53.4%, P = .035), and a higher incidence of asthma (16.1% vs 3.8%, P = .010). Additionally, patients having CRS with the CCAD phenotype demonstrated a high serum total IgE levels (51.6% vs 30.1%, P = .023) in comparison to patients having CRS without CCAD. Conclusion: In pediatric CRS, the radiological CCAD phenotype was associated with allergen sensitization and asthma. Furthermore, the CCAD phenotype was associated with high serum total IgE levels, suggesting allergy etiology should be considered with this type of pediatric patients with CRS.

A comparison of central compartment atopic disease and lateral dominant nasal polyps

“…18 Recently, Lee et al performed a study of pediatric patients (age, <20 years) in Korea and reported that the prevalence of asthma was higher in the CCAD group than in the non-CCAD group (16.1% vs 3.8%, p = 0.01). 17 Our data showed a higher asthma rate in the CCAD population, which contradicts the lower prevalence reported in an earlier study by Marcus et al 9 However, the definitive asthma prevalence did not differ substantially; the asthma prevalence in patients with CCAD was 17.1% in the study by Marcus and colleagues and 11.6% in our study. We assume that the true difference is attributable to the use of different comparison groups.…”

“…Preoperative serum tests from patients with CCAD revealed a higher eosinophil percentage for differential count, which may indicate more inflammation and the atopic status of the patients. Studies conducted in Korea and Taiwan had similar results and showed that patients with CCAD had a higher percentage of peripheral blood eosinophils 16,17 …”

“…Studies conducted in Korea and Taiwan had similar results and showed that patients with CCAD had a higher percentage of peripheral blood eosinophils. 16,17 We found that patients with CCAD usually exhibit more nasal mucosa edematous changes and more blood loss during FESS. Severe inflammation with eosinophil infiltration was also observed microscopically in tissues collected during the operation.…”

“…Brunner et al found no significant difference in asthma rate between patients with isolated middle turbinate polyposis and frank sinonasal polyposis in a Caucasian population (34% vs 22%, p = 0.21) 18 . Recently, Lee et al performed a study of pediatric patients (age, <20 years) in Korea and reported that the prevalence of asthma was higher in the CCAD group than in the non‐CCAD group (16.1% vs 3.8%, p = 0.01) 17 …”

“…Table 4 lists the current results available from the Western and Asian populations (Table 4). 7,9,10,15–18 Thus, we conducted this cross‐sectional study to determine the clinical presentations, risk factors, and surgical outcomes of patients with CCAD in Taiwan. We found that the prevalence of asthma and AR symptoms was higher in CCAD patients compared with LDNP patients.…”