Patient Journeys in Allergic Rhinosinusitis: Topical Antimicrobial and Microbiome-Modulating Interventions

Abstract

Background: The sinus microenvironment is pivotal in the pathogenesis of allergic rhinitis and asthma, as it harbors diverse microorganisms vital for proper immune responses.
Aim: This study aimed to evaluate the clinical, radiologic, and microbiological effects of a topical povidone-iodine irrigation regimen as a microbiome-modulating intervention in patients with allergic rhinosinusitis.
Material and Method:
This study employed a single-arm prospective longitudinal clinical cohort design to assess therapeutic approaches for chronic or recurrent allergic rhinosinusitis at four intervals. The study included 26 adult volunteers aged 20 to 64 with a previous diagnosis of ARS. Various data collection points were employed to assess safety, efficacy, and patient-reported outcomes. Outcome measures comprised radiographic evaluations utilizing the Lund-Mackay Scoring system, olfactory assessments, quality of life evaluations through visual analog scales, and biochemical analyses of nasal cultures and serum IgE levels. A thorough statistical analysis was conducted, utilizing repeated-measures ANOVA and correlation coefficients, with statistical significance set at p < 0.05.
Results:
The results revealed a heterogeneous patient cohort (N=26) with a mean age of 33.5 years, primarily female (61.5%). They displayed diverse health profiles concerning allergic rhinosinusitis (ARS), characterized by elevated systemic antibiotic utilization (58%) and a history of endoscopic sinus surgery (39%). The study indicated substantial enhancements …over four prespecified time points (T0–T3) spanning a 3-week period (2 weeks of active irrigation followed by 1-week off-treatment follow-up) in quality of life (QoL VAS) and olfactory function, accompanied by notable decreases in symptom severity and sinus inflammation, as demonstrated by a drop in LMS score (from 4.1 to 3.2) and successful microbial management. Adverse events were predominantly moderate and temporary, affirming a positive safety profile.
Conclusion
Results demonstrate significant enhancements in endoscopic, symptomatic, functional, and microbiological outcomes following treatment, albeit steady systemic IgE levels.