High-Risk Phenotype Identified for Acute Exacerbation of Chronic Rhinosinusitis

rhinosinusitis reduced with smoking cessation
rhinosinusitis reduced with smoking cessation
Patients with acute exacerbations of chronic rhinosinusitis have appear to have a high-risk phenotype.

Patients with acute exacerbations of chronic rhinosinusitis (AECRS) have appear to have a high-risk phenotype, according to study results published in The Journal of Allergy and Clinical Immunology.

The aim of this retrospective cohort study was to assess potential clinical factors associated with AECRS. Data were collected from electronic medical records at Northwestern University clinics via the Enterprise Database Warehouse. Patients were included if they met the criteria for acute or chronic sinusitis, had sinomucosal inflammation according to a sinus computed tomography scan, and were evaluated in either the Otolaryngology or Allergy and Immunology clinics at Northwestern University in Chicago, Illinois.

Patients were considered to have frequent AECRS if they received ≥4 prescriptions for antibiotics over the course of 12 months because of worsening sinus symptoms. Forced expiratory volume in 1 second was used to classify patient into mild (>80% predicted), moderate (60%-80% predicted), or severe (<60% predicted) asthma, and sinus computed tomography scans were used to assess nasal polyposis and sinus surgery. Other assessed clinical factors included allergic rhinitis, eosinophil count ≥150/μL, antibody deficiency, drug allergies, and autoimmune diseases.

Of the 3109 patients with CRS included in this study, 19.3% had frequent episodes of AECRS. There were some significant differences between the 2 cohorts of patients; the cohort with frequent episodes of AECRS had more women (P =.012), more patients of non-white race, and higher body mass index (P =.03). Compared with the cohort with infrequent exacerbations, the patients with frequent AECRS also had more severe asthma, allergic rhinitis, eosinophil counts ≥150/μL, nasal polyps, autoimmune diseases, antibody deficiencies, and drug and/or antibiotic allergies.

Study limitations included its retrospective design, the potential lack of generalizability of the study population, an inability to assess antibiotic medication adherence, the lack of analysis of the potential effect of immunomodulatory drugs on exacerbations, and using the nonvalidated method of using computed tomography scans to assess sinuses.

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The researchers concluded, “This study identifies associations between high-risk patients with CRS experiencing frequent exacerbations requiring antibiotics, and allergic and immunologic diseases. Improved understanding of this patient population can lead to targeted interventions to reduce exacerbation frequency.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Kwah JH, Somani SN, Stevens WW, et al. Clinical factors associated with acute exacerbations of chronic rhinosinusitis [published online January 28, 2020]. J Allergy Clin Immunol. doi:10.1016/j.jaci.2020.01.023