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Primary Immunodeficiencies in Patients with Recurrent Ear and Sinus Infections

      Rationale

      Primary immunodeficiencies (PIDs) frequently present with otolaryngologic infections but they are usually overlooked mostly because upper respiratory tract infections are common in general population. We aimed to determine the frequency of PIDs in patients with recurrent and/or chronic ENT infections.

      Methods

      We have started reviewing records of patients referred to Allergy/Immunology clinic with the diagnosis of chronic rhinitis, rhinosinusitis, recurrent sinusitis, recurrent otitis, and chronic otitis between July 2009 and July 2012. Patients who met the criteria of chronic (>12 weeks) or recurrent (>3 times/year) sinusitis and/or ear infections underwent immunologic evaluation. Patients with cystic fibrosis and anatomic defects were excluded. Demographic data, and associated factors, including recurrent pneumonias, asthma, and smoking exposure, were reviewed. Immunologic evaluation included CBC with differential, IgG, IgM, and IgA levels, lymphocyte subsets by flow cytometry and complement classic pathway assay (CH50) as well as baseline and post-vaccination pneumococcal and tetanus antibody titers were reviewed.

      Results

      There were 185 patients referred and to date, we have reviewed 82 charts. Forty-three patients (33 children, 10 adults) underwent immunologic evaluation. Eight patients (18.6%) had abnormal immunologic findings: 4 had low IgG, 2 had selective IgA deficiency, and 2 patients had specific antibody deficiency. Twenty-five percent (2/8) of these patients did not have any history of lower respiratory tract infections.

      Conclusions

      Primary immunodeficiency disorders are not rare in patients with recurrent and/or chronic ENT infections and they should be considered in the differential diagnosis.