The role of allergy in sinusitis in adults.

Allergic sinus disease in adults has not been definitively established. On the other hand, sinusitis is more common in allergic individuals than control subjects. Nasal provocation studies with allergens produce clinical findings and radiographic evidence suggestive of allergic sinusitis. Studies that use single-photon emission computerized tomography do not confirm direct entry of pollens into the sinuses. Fungal sinusitis typically occurs in patients with allergic rhinitis and nasal obstruction for many years. Patients often have an elevated specific IgE and total IgE with positive skin tests to the fungus involved. The diagnosis is confirmed by computed tomographic scan or magnetic resonance imaging of the sinuses. There is no direct fungal invasion. Many patients who have chronic severe sinusitis, asthma, and frequently aspirin idiosyncrasy appear to have immunologic reactions in the sinuses (and bronchial tissue). Histologic findings of the sinus mucosa show infiltration with plasma cells and eosinophils. Immunofluorescent stains show IgE dispersed throughout the tissue possibly in plasma cells. An intense linear stain for IgD is found along the epithelial side of the basement membrane.