November 2005

AAAAI, ACAAI identify new recommendations for sinusitis diagnosis and management

From the Journal of Allergy & Clinical Immunology

Sinusitis is one of the most diagnosed diseases in the United States, affecting approximately 16% of the adult population, and is responsible for nearly $5.8 billion in health care costs annually, according to an updated practice parameter. The Diagnosis and Management of Sinusitis: A Practice Parameter Update is featured in the December 2005 issue of the Journal of Allergy & Clinical Immunology (JACI) and is currently available on the JACI's Web site at www.jacionline.org. The JACI is the peer-reviewed, scientific journal of the American Academy of Allergy, Asthma & Immunology (AAAAI).

The practice parameter provides an updated definition of sinusitis and new recommendations for the diagnosis and management of sinusitis, including predisposing factors, antibiotic use, when to see a specialist, and other diseases associated with sinusitis.

"This practice parameter is intended to improve on the diagnosis and management of patients," said Raymond G. Slavin, MD, MS, FAAAAI, and lead author of the updated practice parameter. "This will result in reduced health care costs, and a better quality of life for patients with sinusitis."

Sinusitis is an inflammation of one or more of the paranasal sinuses, and can be divided into acute, subacute, chronic and recurrent. The classifications are based on how long symptoms last, the specific sinus involved, or both. The updated classification is as follows:

Acute sinusitis: symptoms for less than 4 weeks consisting of some or all of the following: persistent symptoms of an upper respiratory tract infection, purulent rhinorrhea, postnasal drainage, anosmia, nasal congestion, facial pain, headache, fever, cough, and purulent discharge.
Subacute sinusitis: symptoms from four to eight weeks.
Chronic sinusitis: symptoms for eight weeks or longer of varying severity consisting of the same symptoms as seen in acute sinusitis. In chronic sinusitis there should be abnormal findings on CT or MRI. Some patients with chronic sinusitis might present with vague or insidious symptoms.
Recurrent sinusitis: three or more episodes of acute sinusitis per year. Patients with recurrent sinusitis might be infected by different organisms at different times.

The two most common predisposing conditions to developing sinusitis are viral upper respiratory tract infections and allergic rhinitis. Allergic rhinitis is one of the most common chronic diseases, affecting up to 35.9 million Americans annually.

The diagnosis of sinusitis is based on a combination of clinical history, physical examination, imaging studies, and/or laboratory tests. The Diagnosis and Management of Sinusitis: A Practice Parameter Update recommends:

The diagnosis of acute sinusitis should be primarily based on the history and physical examination of the patient. Imaging techniques such as radiographs or CT scans are not necessary.
Antibiotics should be withheld for 10 to 14 days, unless severe symptoms develop such as fever, facial pain or tenderness, or swelling around the eye.
The primary therapy for acute bacterial sinusitis is antibiotics, but with increasing resistance to penicillin being reported, alternative antibiotics may be necessary.
Referral to an allergist/immunologist, particularly for patients with chronic or recurrent sinusitis associated with certain conditions, and in patients who have undergone prior surgical procedures and continue to experience sinusitis.
Surgery is a consideration only after medical therapy has failed.

According to the practice parameter and the AAAAI, referral to an allergist/immunologist should be sought when:

The patient suffers chronic, recurrent infectious or fungal rhinosinusitis.
There is a need to clarify whether an allergic or immune deficiency condition is playing a role.
If the sinusitis does not respond to the usual antibiotic treatment.
If the sinusitis significantly affects performance and quality of life.
The sinusitis co-exists with allergic rhinitis.

Working with an allergist/immunologist, the best qualified medical professional trained to manage the prevention, diagnosis and treatment of sinusitis and other allergic diseases, will demonstrate improved outcomes and quality of life for people suffering from allergic disease.

To find an allergist/immunologist in your area or to learn more about sinusitis, call the AAAAI Physician Referral and Information Line at (800) 822-2762 or visit the AAAAI Web site at www.aaaai.org.

The Diagnosis and Management of Sinusitis: A Practice Parameter Update was developed by the Joint Task Force on Practice Parameters for Allergy & Immunology, a joint coalition of the American Academy of Allergy, Asthma & Immunology (AAAAI), the American College of Allergy, Asthma & Immunology's (ACAAI), and the Joint Council of Allergy, Asthma and Immunology (JCAAI). The AAAAI is the largest professional medical specialty organization in the United States representing allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic disease. Allergy/immunology specialists are pediatric or internal medicine physicians who have elected an additional two years of training to become specialized in the treatment of asthma, allergy and immunologic disease. Established in 1943, the AAAAI has more than 6,000 members in the United States, Canada and 60 other countries. The AAAAI serves as an advocate to the public by providing educational information through its Web site at www.aaaai.org.