Individuals who experience frequent sinus infections are familiar with the discomfort and inconvenience of repeated Illness, and are exposed to the risk of complications from the disease itself or from the antibiotic therapy frequently used in treatment. As patients and physician struggle to identify the underlying cause, patients may wonder if their immune system is defective and unable to fight infections appropriately. For most patients, the explanation lies somewhere else, however, for a small percentage of patients, a defect in their immune system, or an immune deficiency may be playing a role in the recurrent disease.
Immune deficiencies occur when a component of the complex system which constitutes the immune system does not function appropriately. Given the complexity of the immune system, this is hardly surprising.
The most common immune deficiency is the common variable immunodeficiency, where the body does not produce enough immunoglobulins useful for fighting infection. More recently, physicians increasingly identify deficiencies at the level of white blood cells. These include deficiencies in neutrophils, white blood cells specialized and fighting infection, and lymphocytes, specialized white blood cells which perform a host of functions including production of antibodies, direct killing of diseased cells, or regulation of inflammatory processes.
In addition to these diseases, modern investigative techniques including advances in genetics have identified multiple new mechanisms of the immune deficiency which were previously unsuspected. These include dysfunctions in the innate immune system, a component of the immune system unknown 20 years ago.
How do you know if you have an immune dysfunction?
Clinicians will frequently suspect an immune dysfunction in individual with repeated infections that are severe in nature. These include episodes of pneumonia, severe gastrointestinal infection, infections which require treatment with antibiotics administered intravenously, or certain unusual infections. A family history of severe infections or known immunodeficiency may also increase suspicion. Finally, in a perplexing paradox, individuals who manifest signs of autoimmunity may also have elements of immune deficiency implicated in the care.
When suspected, diagnosis of immune deficiencies are made by specialized blood testing. Commonly available tests, such as measurement of immunoglobulins such as IgG, may identify common deficiencies, but in certain complicated cases, specialized testing available only from specialized institutions is required.
Patients who suspect an underlying in deficiency as a cause for their sinusitis should discuss with their physician whether screening for common immune deficiencies should be performed or referral for further specialized testing
Prepared by: Hugo Chapdelaine, MD, FRCPC, Division of Allergy and Clinical immunology, Université de Montréal.obtained.
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