Multifactorial Analysis of Central Compartment Atopic Disease: Atopy, Comorbid Asthma and Radiological Sinus Involvement

Background: Central compartment atopic disease (CCAD) is a recently developed terminology used to describe a specific phenotype of chronic rhinosinusitis (CRS). The aim of this study is to provide a thorough analysis of the clinical and radiological characteristics by assessing the prevalence of symptoms, asthma, allergy, aeroallergen sensitization and radiological sinus involvement. Methods: The authors searched for articles on PubMed, Cochrane, and Embase databases. A review of the articles was carried out following PRISMA guidelines; all articles were assessed for quality according to NICE criteria. Afterwards, the meta-analysis was performed with STATA 18SE software. Studies were also assessed for heterogeneity and risk of publication bias. Mean Lund-Mackay (LMK) score of patients with and without CCAD was compared. Results: A total of 16 studies were included, including 1254 patients with CRS; 537 of these were diagnosed with CCAD. The most prevalent symptoms were obstruction at 78% and congestion at 70%, followed by rhinorrhea at 66%, hyposmia at 54%, and facial pain at 24%. Dust mite at 71% was the most prevalent sensitization. Overall, the prevalence of asthma in patients with CCAD was 26%, prevalence of allergy was 67%. The mean difference in LMK scores was −3.38 in CCAD. Conclusions: Patients frequently present with nasal obstruction and congestion; the most common allergen sensitization is to dust mites. Findings on allergy and asthma prevalence support the “Unified Airway Disease” concept and emphasize the importance of a multidisciplinary approach to managing this phenotype. CCAD patients usually do not develop very high LMK scores; high scores may rule out this diagnosis. PROSPERO registration number: CRD420261361696.