Predictors and their significance in the treatment of inflammation of the nasal cavity and paranasal sinuses of allergic etiology

Clinical symptoms evaluation is of great importance for an appropriate management of patients with respiratory allergy. Concomitant diseases shoud be taken in consideration before the choice of the necessary treatment options and nasal allergic inflammation pharmacotherapy. Mostly in case of nasal clinical symptoms the anatomic variations of the nasal cavity, type of sinusinflammation as well as the major nasal complaint shoud be analysed before the rational choice of treatment option. Materials and methods: 16 patients (9 males and 7 women, median age 40+13.72) with clinical symptoms of respiratory allergy were examined and divided into two groups according their sinus inflammation involvement. Nasal clinical symptoms according VAS and individual anatomy were analysed. 7 patients with allergic rhinitis without concomitant sinus inflammation were set to the first group and 9 patients with concomitant central compartment inflammation of ethmoid and maxillary sinuses were set to the second one. Individual anatomy variations and sinuses inflammation according Lund-Mackay score were evaluated by means of CT scans. Atopic state was confirmed by levels of blood sIgE with ImmunoCAP assay (Phadia). Other allergy tests included blood level of general IgE, eosinophilic cationic protein and parameters of respiratory function. Results: the group difference was supposed in case of anterior or middle nasal septal deviation with the strong correlation to central compartment maxillary and ethmoid sinuses inflammation (x2 Pearson = 0.645, p = 0.009). Also, the results supposed the group difference in symptoms of nasal obstruction. Almost all patients of group with concomitant sinus inflammation didn’t present to the doctor with the major complaint of nasal obstruction (88.9%, p = 0,049). Rhinorrhea as major symptom was presented by 44.9% patients of this group. Discussion: clinical options for rational pharmacotherapy choice in patients with respiratory allergy should include nasal obstruction evaluation in case or individual anatomy and concomitant inflammation of paranasal sinuses central compartments.