The role of allergy in pediatric rhinosinusitis

PURPOSE OF REVIEW: This review focuses on the association between allergic disease and pediatric rhinosinusitis. For this purpose, allergic rhinitis and chronic rhinosinusitis (CRS) were the areas chosen for further discussion. RECENT FINDINGS: The role of allergy as a major immunopathologic mechanism causing inflammation in pediatric rhinosinusitis is becoming better defined. However, despite the fact that allergic rhinitis and CRS are characterized by inflammation, there appears to be a distinct difference in the inflammatory response of children and adults with CRS, which may attest to a difference in the pathophysiologic pathways. Local allergic rhinitis, a recently described pathological entity, appears to affect a significant number of patients with a previous diagnosis of nonallergic rhinitis, making this a prevalent entity in patients evaluated with rhinitis. With regard to the relationships between allergy and infectious diseases, it has been reported that basophils are activated in the presence of suboptimal doses of allergens and bacteria and may explain the clinical behavior of allergy exacerbation. SUMMARY: Allergic rhinitis is frequently associated with CRS. The management of CRS should include evaluation of the pediatric patient for allergic disease and the management should be targeted at decreasing the inflammatory response, which will most likely result in better control of the CRS patient.