Association Between Atopic Dermatitis and Recurrent Sinusitis

Introduction to Atopic Connection

Atopic dermatitis, allergic rhinitis, and sinusitis are part of the "atopic march," where patients with one atopic condition are at increased risk for developing others, as noted by the American Academy of Otolaryngology-Head and Neck Surgery 1
The prevalence of allergic rhinitis is 40% to 84% in adults with chronic rhinosinusitis, suggesting a strong association between these atopic conditions, according to the American Academy of Otolaryngology-Head and Neck Surgery 2

Edema caused by allergic inflammation may obstruct the paranasal sinuses, as supported by a higher prevalence of mucoperiosteal disease on CT imaging in patients with allergies, as reported by the American Academy of Otolaryngology-Head and Neck Surgery 2
A hyperresponsive inflammatory state associated with allergic rhinitis may increase susceptibility to inflammation within the nose and paranasal sinuses, predisposing to rhinosinusitis, according to the American Academy of Otolaryngology-Head and Neck Surgery 2

Patients with recurrent sinusitis should be evaluated for underlying allergic factors, including atopic dermatitis and high IgE levels, as recommended by the Journal of Allergy and Clinical Immunology 3
Extensive sinus disease on CT imaging is associated with allergy in 78% of patients and asthma in 71%, as found by the American Academy of Otolaryngology-Head and Neck Surgery 4
Patients with both allergy and chronic rhinosinusitis are more symptomatic than non-allergic patients with similar CT findings, according to the American Academy of Otolaryngology-Head and Neck Surgery 2

Allergy testing is recommended for patients with chronic or recurrent acute rhinosinusitis, as suggested by the American Academy of Otolaryngology-Head and Neck Surgery 2
Skin tests are the preferred method for detecting IgE-mediated sensitivity, with in vitro allergen-specific immunoassays as an alternative, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 2
Immunodeficiency evaluation should be considered in patients with recurrent sinusitis resistant to standard therapy, particularly when accompanied by other recurrent infections, as advised by the Journal of Allergy and Clinical Immunology 5 and 6

Common variable immunodeficiency (10%) and IgA deficiency (6%) have been found in patients with radiographically diagnosed sinusitis refractory to medical and surgical therapy, as reported by the Journal of Allergy and Clinical Immunology 7
Laboratory studies for patients with recurrent sinusitis should include quantitative immunoglobulin measurements (IgG, IgA, IgM) and specific antibody responses to vaccines, as recommended by the Journal of Allergy and Clinical Immunology 8

Environmental control measures for relevant allergens, pharmacotherapy with intranasal corticosteroids, and consideration of allergen immunotherapy for selected patients are recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1 and 2
Antibiotics for bacterial infections, with extended courses for recurrent cases, and consideration of broader-spectrum antibiotics for poor response, are suggested by the Journal of Allergy and Clinical Immunology 3
Allergist-immunologist consultation for evaluation of underlying allergic factors and possible immunodeficiency, and otolaryngology referral for evaluation of structural abnormalities, are recommended by the Journal of Allergy and Clinical Immunology 3