Central compartment sinus disease: A local sinonasal inflammatory response to environmental allergens

Central compartment atopic disease is a recently defined endotype of chronic rhinosinusitis (CRS) with nasal polyps associated with allergic sensitization. 1 DelGaudio JM Loftus PA Hamizan AW Harvey RJ Wise SK Central compartment atopic disease. Am J Rhinol Allergy. 2017; 31: 228-234 Google Scholar Aeroallergen exposure in the nasal compartment of sensitized individuals may lead to immunoglobulin (Ig)E-mediated inflammation and middle turbinate edema, a specific endoscopic sign of aeroallergen sensitization. 2 White LJ Rotella MR DelGaudio JM Polypoid changes of the middle turbinate as an indicator of atopic disease. Int Forum Allergy Rhinol. 2014; 4: 376-380 Google Scholar ,3 Hamizan AW Christensen JM Ebenzer J et al. Middle turbinate edema as a diagnostic marker of inhalant allergy. Int Forum Allergy Rhinol. 2017; 7: 37-42 Google Scholar This disease variant links mucosal changes isolated to the central compartment of the paranasal sinuses with the presence of environmental allergies. Radiologically, this is seen as soft tissue or mucosal thickening in the central portion of the sinonasal cavity while sparing the roof and lateral walls. 4 Hamizan AW Loftus PA Alvarado R et al. Allergic phenotype of chronic rhinosinusitis based on radiologic pattern of disease. Laryngoscope. 2018; 128: 2015-2021 Google Scholar It is thought that inhaled allergens may lead to inflammation of the central nasal cavity more than the peripheral sinuses owing to laminar airflow. Herein, we describe a retrospective study evaluating the association between environmental allergen sensitization and the presence of central compartment mucosal disease (CCD) in the paranasal sinuses to understand the role of systemic inflammation in CCD.