[PAGID] Chronic rhinosinusitis in antibody deficiency diseases

[Ashish Kumar]

Hi Ken! Great to hear from you after our a long time since we met in 
Miami. Thanks for this info.
Ashish

Paris, Kenneth wrote:

> 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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