[PAGID] Chronic rhinosinusitis in antibody deficiency diseases

[Paris, Kenneth]

Ashish,
 
At our center we use daily intranasal mupirocin ointment in this situation.  It may help extend the asymptomatic intervals.  Our thoughts are that it may help reduce colonization with pathogenic bacteria that can cause sinusitis.  Prolonged use may contribute to some resistance, but the same risk occurs with prophylactic oral abx.  We sometimes enlist help from our ENT colleagues to help identify the pathogen and get resistance profiles, especially if we suspect a resistant bacteria  (we always specify that we do not want procedures that may disrupt normal anatomy).   Many, if not all of our XLA patients have had issues with chronic/recurrent sinusitis despite adjustments in dose of IgG.  Lack of mucosal IgA isn't overcome by IVIG, so these types of infections are common.
 
Kenneth Paris MD, MPH
Assistant Professor of Pediatrics
Division of Allergy and Immunology
LSU Health Sciences Center
Children's Hospital of New Orleans
 
Mail: 
200 Henry Clay Avenue
Children's Hospital 
Research Institute for Children 4th Floor
New Orleans, LA 70118
 
Phone:  504-896-9589
Fax:  504-896-9311
Email:  kparis at lsuhsc.edu
 
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________________________________

From: pagid-bounces at list.clinimmsoc.org on behalf of Ashish Kumar
Sent: Tue 6/3/2008 9:53 AM
To: Pagid
Subject: [PAGID] Chronic rhinosinusitis in antibody deficiency diseases



The mother of one one of my patients with XLA does not want to use
prolonged antibiotics for the management of his chronic rhinosinusitis.
His symptoms disappear while on he is on Augmentin but reappear when
stopped. Has anyone tried nasal steroids alone or in combination with
antibiotics/higher dose of IVIG successfully?
Is there published consensus on the appropriate management of chronic
rhinosinusitis in patients with antibody deficiency diseases - most of
what I found suggest that there is none. Maybe an opportunity for a
collaborative group trial?

--
Ashish Kumar, MD, PhD
Assistant Professor of Pediatrics
Division of Hematology/Oncology/Blood and Marrow Transplantation
University of Minnesota

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