Primary Antibody Deficiency in Patients With Chronic Rhinosinusitis: A Call for Immunologic Evaluation Prior to Biologic Therapy

Objective Chronic rhinosinusitis (CRS) is prevalent and causes a great negative impact on quality of life. Primary antibody deficiency (PAD) is highly prevalent with CRS compared to the background population. There are efficient treatment options to consider when CRS is a symptom of PAD. The condition seems to be underdiagnosed. Design A prospective cohort study investigating adults with CRS for PAD. Results One hundred and thirty‐eight patients were included in the study. Mean age was 49 years. Twenty‐nine (21%) had hypogammaglobulinemia. Nine of 83 (11%) patients had insufficient response to pneumovax polysaccharide vaccine, but insufficient clinical history for diagnosis of Specific Antibody Deficiency (SPAD). Four patients met the clinical criteria for PAD; one had Common Variable Immune Deficiency (CVID), one had IgA deficiency, and two had IgG subclass deficiency. No clinical characteristic was predictive of PAD, and severity of CRS was not indicative of hypogammaglobulinemia or insufficient vaccine response. Conclusion Immunoglobulin testing should be a routine part of the diagnostic work‐up in chronic rhinosinusitis before considering biologics, as primary antibody deficiency is an under‐recognised but treatable cause of refractory disease.