The Role of Allergy in Central Compartment Atopic Disease

Central compartment atopic disease (CCAD) is a variant of chronic rhinosinusitis with nasal polyps (CRSwNP) that is highly associated with aeroallergen sensitivity. The purpose of this review is to define this relationship and highlight the clinical manifestations and treatment strategies for this condition.

CCAD presents with polypoid mucosal changes or frank polyps in the central compartment of the nasal cavity, defined as the middle and superior turbinates and the posterior superior nasal septum. These changes can be observed both endoscopically and via imaging. It is more strongly associated with allergic rhinitis than the other subtypes of CRSwNP, with increased allergic symptoms and eosinophilic nasal polyps. Local allergy may also play an important role. Treatment strategies are not yet well-defined, and endoscopic sinus surgery (ESS), nasal steroid or saline irrigation, and allergen immunotherapy are all treatment options.

CCAD is a developing but distinct subtype of CRSwNP with a unique presentation, pathophysiology, relationship with allergic rhinitis, and possible therapeutic management compared to other endotypes. Continued research is necessary to further define the treatment options for this disease process to best manage the increasing number of affected patients.