[Immunoglobulin subclass defects in patients with therapy refractor chronic rhinosinusitis].

In the present study 220 patients suffering from recurrent rhinosinusitis and not responding to antibiotic treatment were evaluated for a defect in IgG-immunoglobulin subclasses. Twenty-one of these patients were found to have an antibody deficiency. These included deficiencies of IgG-2 (n = 10), IgG-1 (n = 6), IgG-3 (n = 1) and IgG-4 (n = 1). A common variable immune disease was diagnosed in three patients that was characterized by an additional defect in the IgG main class. However, an IgG subclass deficiency can only be ascertained by an immunological evaluation. The significance of a deficiency can be identified by a reaction to vaccination using (for example) protein or polysaccharide antigens. Treatment consists of antibiotics, intravenous immunoglobulins and long-term follow-up. Endonasal microsurgery should only be performed in cases that do not respond to conservative treatment. It is particularly necessary to observe these patients because a deficiency of immunoglobulin subclass in certain cases is the first sign of an immunological impairment that can advance to a severe immunodeficiency and predispose to the development of malignancy.