Objective: To evaluate the prevalence of humoral immunodeficiency in patients with refractory rhinosinusitis.
Methodology: All patients with refractory rhinosinusitis, who were treated at or referred to the ENT Dept of the University Hospital in Leuven between January 2002 and December 2004, were retrospectively identified. Patient charts that contained information on humoral immunity testing were selected to calculate the prevalence of IgA deficiency, common variable immunodeficiency (CVID) and IgG2/3 subclass deficiency.
Results: A total of 307 subjects (261 adults and 46 children) were included. Overall, 67 patients (21.8%) with refractory rhinosinusitis had laboratory evidence of a humoral immunodeficiency. We found an IgA deficiency in 7 patients (2.2%); CVID was not found in any patient (0%); IgG2 subclass deficiency in 6 patients (2.0%) and IgG3 subclass deficiency in 55 patients (17.9%). Nine patients (2.9%) had combined deficits of major and/or subclass serum immunoglobulin levels. There was no significant difference in the prevalence of humoral immunodeficiency between adults and children.
Conclusion: Humoral immunodeficiency is present in a significant proportion of patients with refractory rhinosinusitis. The majority of these deficiencies are subtle IgG subclass deficits, whereas more severe humoral immune disorders are a rare finding. A laboratory evaluation of humoral immune function, including measurement of serum levels of IgA, total IgG and IgG subclasses, should be part of the evaluation of patients with refractory rhinosinusitis.