Chronic sinusitis, also called chronic rhinosinusitis (CRS), is the fifth most common condition treated with antibiotics, accounting for up to 22 million physician visits and up to $5 billion in annual costs. According to the National Institutes for Health, it affects about 14.6% of the US population.
The frequency of persons with allergy symptoms who truly have CRS is examined in new research from the University of Cincinnati, a discovery that may have implications for treating allergy symptoms.
Lead author of the study and director of the Division of Rhinology, Allergy, and Anterior Skull Base Surgery at the UC College of Medicine Ahmad Sedaghat, MD, Ph., notes that “we have seen in our clinical practices many instances where patients have believed they have allergies for many years and have sought treatment for allergies.”
“They have always had CRS, an inflammatory disorder of the sinuses, thus they have never been able to get rid of their sinus/nasal problems. This is particularly true, we have discovered, in places like the Cincinnati/Ohio River valley region, where environmental allergies are very common.
“As someone who grew up in this area, I can relate to how frequently we blame sinus and nasal issues on ‘allergies.’ This is because nasal allergies (allergic rhinitis) and CRS have similar symptomatology, which is frequently characterized by nasal obstruction and discharge. “Both can cause sinus pressure,” Sedaghat explained.
“Despite their common clinical symptoms, however, nasal allergies and CRS in many ways have different treatments.”
The research comprised 219 people whose primary complaint was nasal allergies. A 22-item Sinonasal Outcome Test was administered to all participants to assess the severity of sinus/nasal symptoms, and an endoscopic score was established based on nasal endoscopy results.
Although 91.3% of the patients exhibited environmental allergies, 45.2% had been diagnosed with CRS. Approximately half of CRS patients reported not using intranasal corticosteroids, which are the primary therapeutic approach.
“We specifically used this questionnaire to study our patients’ symptoms because we could simultaneously measure symptoms of CRS and allergic rhinitis without having to use different questionnaires,” Sedaghat said.
“However, I’d want to stress that our findings and how they apply to patients differ from the [test]. We discovered that at particular sinus/nasal symptom severity thresholds, patients should evaluate the potential of CRS; nevertheless, these thresholds are stated in ordinary language that patients may easily apply to their personal condition.”
The researchers concluded that the findings have crucial implications for patient education regarding CRS and enhancing CRS health literacy, especially in areas where environmental allergies are both common and culturally ingrained, such as the Cincinnati area. Misinterpretation of CRS for allergic rhinitis may lead to patients receiving AR therapies that are ineffective for CRS, prolonging the patient’s symptoms.
“We have seen so many patients suffer for so long due to the confusion between allergies and CRS,” Sedaghat said. “I’ve had patients tell me that they had been treated with allergy injections for ten, twenty, or more years without alleviation of their symptoms, but that once we determined they had CRS and began them on appropriate medication, they saw relief within a few months.
“I’m excited to be able to find a way to empower patients to think about the possibility of CRS, and I’m excited that we were able to do it in a way that will be very easy for patients.”
“I’m also happy to shed focus on this critical issue that so many people in our community are facing. “Almost half of the patients who came to see us for what they thought were nasal allergies had CRS,” Sedaghat said. “Given how commonly we talk about ‘allergies’ in this region, imagine how many patients may be undertreated and how many patients can be positively impacted by seeking out care for the possibility of CRS.”
The study’s findings advise that individual patients and communities be counseled to evaluate the likelihood of CRS when their nasal blockage or discharge symptoms become moderate or severe, or if they observe any degree of impaired sense of smell.
“I hope that this study will provide us with the tools to increase public awareness of CRS, especially for those who are most likely to have it but have it misdiagnosed,” says Sedaghat. “These tools, like self-administered, easily-understood questions, will assist the significant number of patients who continue to experience nasal and sinus symptoms despite allergy treatments in seeking out additional care for CRS.”
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