Chronic rhinosinusitis is thought to affect 1.5%–2% of children and negatively impacts their quality of life. An increased risk of rhinosinusitis has been described among adults with autoimmune disorders. However, the relationship between autoimmune or autoinflammatory diseases and chronic rhinosinusitis in children has not been well elucidated.
On the second day of the 2024 American Rhinologic Society (ARS) meeting at the COSM, held on May 15–16, 2024 in Chicago, Sairisheel Gabbireddy, MD from West Virginia University presented data that offered an insight into this relationship.
To determine whether autoimmune and autoinflammatory disorders are associated with an increased risk of chronic rhinosinusitis in children, the investigators conducted a 1:1 matched, case-control, retrospective study on pediatric patients who had been seen at West Virginia University in the preceding 10 years. Children with autoimmune and autoinflammatory diseases were identified based on the International Classification of Diseases (ICD)-10 diagnostic codes. Overall, 4,498 children were included, among which 2,249 had an autoimmune or an autoinflammatory disorder, and 2,249 were matched controls without any autoimmune or autoinflammatory condition. Univariate and multivariate logistic regression were used to assess the strength of the association between autoimmune and/or autoinflammatory disorders and chronic rhinosinusitis. The odds ratios (ORs) and 95% confidence intervals (CIs) calculated using multivariate logistic regression were adjusted for potential confounders, including demographic characteristics (age, sex, and race) and certain comorbidities. Finally, the analysis was stratified by disease type (an autoimmune versus an autoinflammatory disorder) to evaluate the risk of chronic rhinosinusitis in each disease type.
In children with autoimmune/autoinflammatory disorders, there was an increased risk of chronic rhinosinusitis (OR = 4.8, p < 0.01), chronic rhinitis (OR = 3.3, p < 0.01), upper respiratory infections (OR = 2.1, p < 0.01), asthma (OR = 2.7, p < 0.01), and immunodeficiency disorders (OR = 27.2, p < 0.01).
Interestingly, when the analysis was stratified by disease type, the association between autoinflammatory diseases and chronic rhinosinusitis (OR = 8.0, p < 0.01) was more pronounced than that between autoimmune diseases and chronic rhinosinusitis (OR = 3.4, p < 0.01). The associations with chronic rhinitis (OR = 6.6, p < 0.01 vs OR = 2.9, p < 0.01) and asthma (OR = 7.7, p < 0.01 vs OR = 1.9, p < 0.01) were also stronger for pediatric patients with autoinflammatory diseases versus those with autoimmune diseases.
Various mechanisms may be implicated in the increased risk of chronic rhinosinusitis in children with autoimmune and autoinflammatory diseases. Autoimmune disorders are considered to represent dysregulation of the adaptive immunity, in which the immune system fails to correctly discriminate between self and non-self, leading to the generation of autoantibodies. Autoinflammatory diseases are thought to reflect dysregulation of the innate immune response, leading to chronic or periodic systemic inflammation. However, in children with both autoimmune and autoinflammatory diseases, dysregulated signaling cascades, including inflammatory pathways, associated eosinophilia, and immunosuppressive medications may be implicated in the increased risk for chronic rhinosinusitis.
Dr. Gabbireddy also listed the limitations of the study, including its retrospective cross-sectional design, the reliance on ICD-10 diagnostic codes, and the inherent limitations of the used database. Thus, prospective investigations may be needed in the future to prove the causality of the observed relationship.
Altogether, the findings of the study showed that autoimmune and autoinflammatory diseases are associated with an increased risk of chronic rhinosinusitis, chronic rhinitis, and asthma in children. Dr. Gabbireddy concluded by emphasizing the importance of screening patients with chronic rhinosinusitis (and especially pediatric patients) for autoimmune and autoinflammatory conditions, to ensure that they receive timely interventions.