The impact of primary immunodeficiency on the severity of chronic rhinosinusitis

Background: Primary immunodeficiency has been associated with chronic rhinosinusitis (CRS). However, limited evidence exists on how primary immunodeficiencies affect the severity of CRS. Objective: To assess how primary IgA and/or IgG immunodeficiency affects the severity of CRS. Methods: Adult patients at the Beth Israel Deaconess Medical Center in Boston with IgA and/or IgG deficiency (group A) or normal IgA and IgG (group B) were queried between January 1, 2016 and December 31, 2022. Other immunodeficiencies were excluded. The groups were analyzed for prevalence of CRS based on ICD-10 codes. The groups were matched based on demographics and comorbidities. Patients with CRS were analyzed for >3 acute rhinosinusitis (ARS) episodes, mean lifetime ARS episodes, and mean ARS episodes per year (all with or without antibiotic treatment). Additional analyses included need for functional endoscopic sinus surgery (FESS) and mean lifetime FESS procedures based on CPT codes. A logistic regression analysis was then performed over the same parameters. Results: A total of 346 patients had IgA and/or IgG deficiency (group A), and 11,438 patients had normal IgA and IgG (group B). CRS prevalence was higher in group A than group B (12 % vs. 5 %; p < 0.001). Group A had more patients with >3 ARS episodes, higher mean lifetime ARS episodes, and ARS episodes per year, though none of these findings were statistically significant. There was no difference in need for FESS or mean lifetime FESS procedures. Conclusion: CRS prevalence is higher in patients with IgA and/or IgG deficiency, but IgA and/or IgG immunodeficiency does not predispose patients to ARS episodes or predict need for FESS.