Pediatric Rhinosinusitis and Its Relationship to Asthma and Allergic Rhinitis

Abstract

Rhinosinusitis is linked to asthma and allergic rhinitis by a variety of mechanisms. Evidence of rhinosinusitis has been demonstrated in at least 50% of children with asthma. Furthermore, medical and surgical treatment of patients with concomitant rhinosinusitis and asthma has been shown to improve both conditions. These observations suggest that there may be a causal relationship between rhinosinusitis and asthma. Several mechanisms have been proposed to explain this relationship, including naso-pharyngo-bronchial reflexes, post-nasal drainage of cells and inflammatory mediators into the lungs, abnormal breathing, and extension of upper-respiratory inflammation to pulmonary inflammation. The relationship between rhinosinusitis and asthma may also be one of local manifestations of a systemic disease, such as is advanced by the "one airway hypothesis." Similar to the relationship between rhinosinusitis and asthma, evidence of allergic rhinitis has been shown in 36–60% of pediatric patients with chronic rhinosinusitis. The primary mechanism whereby allergic rhinitis may cause rhinosinusitis is inflammation leading to obstruction. The relationship between rhinosinusitis and allergic rhinitis may also be one of local manifestations of a systemic disease, since the most common type of chronic rhinosinusitis, chronic hyperplastic eosinophilic rhinosinusitis, appears to be caused by inflammatory processes that resemble allergic rhinitis.