Cutaneous reactivity pattern and nasal smear cytology in patients with chronic rhinosinusitis with nasal polyps; is it associated with the course of the disease?

Background and Objectives: To determine the association of hyper-reactivity to environmental allergens and mucosal secretion cytology with the course of disease in patients with chronic rhinosinusitis and nasal polyps (CRSwNP). Methods: A cross sectional study was conducted at Tehran Clinic of Asthma and Allergy in 2016. Adult patients who earned the definite diagnosis of CRSwNP and were free of serious underlying disease were selected. A comprehensive history regarding the course of disease was taken. Success or failure of previous interventions was defined as subsiding the symptoms and no need for further invasive intervention of surgery. Physical examination, pulmonary function test, nasal smear from both nasal cavities and skin prick test were performed for all enrolled subjects. The results were compared among participants with different course of disease. Results: A total of 45 patients with mean age of 35.8±11.7 (18 to 60 years) were enrolled. Of the participants, 30 (66.7%) had asthma, medical treatment was failed in 23(51.1%), 25 underwent surgery in whom it was failed in 5 (11.1%). Regardless of course of disease, neutrophilia was the predominant cytology of nasal smear. Of the participants, 17 (37.8%) had no sensitization, while, 11(24.4%) showed mono-sensitization and 17(37.8%) were poly-sensitized. Seasonal allergy was found in 16(35.5%), while, perennial sensitization was in 19 (42.2%). Failures of medical treatment were more sensitized to seasonal allergens (45.2% vs 14.3%, p=0.045). Failures of surgery, were found to have poly sensitization to both of perennial and seasonal allergens (66.7% vs 21.1%, p=0.037). Conclusion: Atopy is frequently present in patients with CRSwNP and pattern of sensitization can affect the outcome of intervention. With respect to different pattern of sensitization among failed and successful interventions, determining the sensitizations prior to any intervention is suggested. Patient counseling regarding the recurrence of disease can be done in accordance with atopic profile.