ST. LOUIS--Sinusitis often occurs in patients who have allergic rhinitis but whether an allergic reaction per se actually occurs in the sinuses has been the subject of debate. A new study has found that the sinuses do not appear to be affected even in patients with severe allergic rhinitis.[1] “Uncomplicated allergic rhinitis is not associated with abnormalities on sinus imaging. Therefore, if a patient with allergic rhinitis has an abnormal sinus x–ray, they probably have an underlying sinus infection,” suggested Raymond G. Slavin, MD, in an interview with RESPIRATORY REVIEWS.

Dr. Slavin and his colleagues studied five patients with classic symptoms of allergic rhinitis during ragweed season. None of the subjects showed any signs or symptoms of sinusitis (eg, facial pain or fullness, purulent nasal discharge), according to Dr. Slavin, who is Director of the Division of Allergy and Immunology at St. Louis University School of Medicine.

All patients underwent extensive radionuclide imaging studies to detect the presence of allergic inflammation of the sinuses. Bone studies revealed that all of the subjects had severe swelling of the nasal turbinates but no increase in sinus uptake. Similarly, none of the three subjects who underwent labeled white blood cell uptake studies showed sinus abnormalities. Even high–resolution fluorodeoxygenase imaging failed to detect any abnormalities in the two patients in whom it was used.

The findings help clarify the distinction between allergic rhinitis and sinusitis, suggested James T. Li, MD, PhD, in an editorial accompanying the article.[2]

The results support those from an earlier study by Leipzig et al,[3] which demonstrated that patients with allergic rhinitis have minimal CT evidence of sinus changes. Other evidence that disputes the concept of allergic sinusitis comes from an earlier study by Dr. Slavin and colleagues, which found that “inhaled ragweed doesn’t reach the sinus cavities.” [4]

Despite the small sample size, Dr. Slavin believes that the current study provides compelling evidence that uncomplicated allergic rhinitis does not involve the sinuses. “We used three very precise imaging techniques to detect inflammation in the sinuses of patients who were highly symptomatic,” said Dr. Slavin. Based on the findings, he concluded that “allergic sinusitis” is not a real entity.

--Deborah L. O’Connor

References
1. Slavin RG, Leipzig JR, Goodgold HM. “Allergic sinusitis” revisited. Ann Allergy Asthma Immunol. 2000;85:273-276.

2. Li JT. The trouble with sinuses. Ann Allergy Asthma Immunol. 2000;85:247.

3. Leipzig JR, Martin DS, Eisenbeis JF, Slavin RG. Computed tomographic study of the paranasal sinuses in allergic rhinitis. J Allergy Clin Immunol. 1996;98:1130-1131.

4. Adkins TN, Goodgold HM, Hendershott L, Slavin RG. Does inhaled pollen enter the sinus cavities? Ann Allergy Asthma Immunol.1998;81:181-184.