Phenotypic Features of Central Compartment Atopic Disease Compared with Other Types of Chronic Rhinosinusitis: A Systematic Review.

PURPOSE OF REVIEW: Central Compartment Atopic Disease (CCAD) is an emerging phenotype of chronic rhinosinusitis. The absence of a standardized diagnostic framework and the presence of heterogeneous reported characteristics underscore the importance of consolidating current knowledge on CCAD. This review aims to enhance understanding of the CCAD phenotype by focusing on its clinical and radiologic features, its association with inhalant allergies, and its therapeutic implications in comparison with other chronic rhinosinusitis phenotypes.

METHODS

A systematic review was conducted through searches in five databases from 2017 to June 2025 following SWiM guidelines. The methodological quality and risk of bias of the included studies were evaluated using the Oxford Centre for Evidence-Based Medicine criteria. Data were analyzed using descriptive and qualitative synthesis.

RESULTS

Seventeen studies were included for qualitative synthesis. CCAD diagnosis relied mainly on endoscopic and radiologic findings, often supported by allergy testing. Most patients showed lower rates of asthma, with variable allergic sensitization rates across populations and elevated blood and tissue eosinophils. Compared to other phenotypes, CCAD showed milder disease and favorable outcomes after endoscopic sinus surgery.

CONCLUSION

CCAD presents unique clinical and immunologic features that differ from other chronic rhinosinusitis subtypes. Standardized diagnostic criteria are needed to improve recognition and guide tailored management strategies.