Evaluation and workup of immunodeficiencies in recurrent acute rhinosinusitis: A scoping review

Primary immunodeficiency disorders (PIDDs) may be a risk factor for development of recurrent acute rhinosinusitis (RARS). There are currently no clear guidelines for the timing and methodology of PIDD testing in patients with RARS. The aim of this scoping review is to identify and analyze existing literature on this topic.

A scoping review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Articles addressing recurrent acute sinusitis and immunodeficiencies were collected from PubMed, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and systematically evaluated for eligibility by two reviewers.

Of the 209 unique articles identified, 11 met criteria for review and analysis. Articles consisted of historical cohort, case-control, and cross-sectional studies, in addition to case series and nonsystematic reviews. The majority (10) recommended immunodeficiency testing, consisting of general immunologic screening (3), quantitative immunoglobulins (6), and postvaccination antibody titers (5). There was an emphasis on immunoglobulin G (IgG) subclass testing (6). Of the eight articles providing timing recommendations, the majority recommended testing after recurrent infections or diagnosis (6); however, criteria for diagnosis of RARS and populations targeted by recommendations varied greatly by article.

Current literature on RARS emphasizes immunoglobulin quantification and postvaccination antibody titers to evaluate for PIDD after diagnosis, but recommendations are limited by wide-ranging populations of interest and inconsistent definitions. This scoping review identified a lack of evidence-based articles specific to diagnostic workup for PIDD in patients with RARS, and additional research with standardized definitions and focus on RARS is necessary to guide clinical practice.