Immunologic Considerations in the Pathogenesis of Chronic and Recurrent Sinusitis in Children

ABSTRACT

PURPOSE: Although the chronic sinusitis is one of the most common and troublesome respiratory diseases in children, the pathogenesis still remains unclear. It is suggested that many of the immunologic factors including allergic conditions may contribute the nasal inflammatory changes. This study was designed to evaluate and demonstrate the possible role of various immunologic factors on the pathogenesis of chronic sinusitis in children. METHODS: During the 6 months study period from March to August, 1995, 33 children with chronic and recurrent clinical symptoms of sinusitis were evaluated. History taking, physical examinatin, paranasal radiologic examination, total IgE, allergen-specific IgE antibodies, serum IgA, IgG subclasses and T cell subsets were analysed in most of the children. RESULTS: The results were as follows; 1) The value of total serum IgE was increased in 19 cases(63.3% of the total). 2) All children in this study shows normal serum IgA levels. 3) In ten of 31 children(74.1%) with chronic sinusitis, serum concentrations of IgG2 were lower than geometric mean value. There was a decreased concentration of IgG1 in 3 cases(21.4%), IgG3 in 4 cases(28.6%), and IgG4 in 2 cases(14.3%). 4) The ratio of T4 to T8 was less than 2 in 23 cases(82.1%) out of 28 cases and reversed in 1 case. 5) Decreased serum concentration of IgG2 was more prevalent in cases with normal serum IgE levels rather than the cases with high serum IgE levels. 6) There was no correlation between the toral serum IgE levels and the ratio of T4 to T8 7) In the case with reversed T4 to T8 ratio, all the IgG subclasses are decreased except IgG3. 8) Chronic cough was the most common clinical manifestations in this study and postnasal drip, purulent nasal discharge, nasal stuffiness, fever and allergic shiner were noted in order. 9) Many of the children in this study have an allergic diseases, such as allergic rhinitis(48.5%), asthma(45.5%), and atopic dermatitis(33.3%). 10) PNS radiographs show diffuse opacification or mucosal thickening in all of the patients. CONCLUSIONS: In this study, we suggested that complex immunologic reactions including IgE-mediated allergic reaction, IgG subclasses deficiencies and cellular immunity are involved in the pathogenesis of chronic and recurrent sinusitis.