DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20193889

A study to evaluate the relationship between serum vitamin d level and chronic rhinosinusitis

Dimple Sahni, Deepika Bagri, Sanjeev Bhagat, Dinesh Sharma, Jasvir Singh

Abstract


Background: Chronic rhinosinusitis (CRS) places a relatively large socioeconomic burden on developed nations, yet remains a difficult disease to treat. Vitamin D3 (VD3) deficiency is reported to be associated with increased incidence of allergic airway diseases. The ability of VD3 to augment innate and adaptive immune responses has sparked interest in its immunologic role in allergy. The objective of the present study is to evaluate the relationship between serum vitamin D level and chronic rhinosinusitis.

Methods: Total 90 patients were included in the study and divided into three groups i.e., 30 patients of chronicrhinosinusitis with nasal polyposis (CRSwNP), 30 patients of chronic rhinosinusitis without nasal polyposis (CRSsNP) and 30 healthy subjects were used as control. The severity of CRSwNP was assessed with the Lund-Mackay (LM) score and polyp grading system. VD3 status was assessed by measuring circulating 25-hydroxyvitamin D (25OHD) by using ELISA.  

Results: Serum 25OHD levels (ng/ml±SD) were significantly lower in patients with CRSwNP (16.16±8.86) than in those with CRSsNP (23.28±5.35; p=0.001) and control 44.37±19.87. The incidence of vitamin D deficiency (<20 ng/ml) in CRSwNP and CRSsNP patients were 60% and 20%; however, the incidence of vitamin D insufficiency (20-30 ng/ml) in these patients were 37% and 70%, respectively. A significantly inverse relationship was found between serum 25OHD level and polyp grade (p=0.048), indicating lower serum 25OHD was associated with higher polyp grade. Serum 25OHD was inversely related to both LM endoscopic and LM CT scan score, which is found to be significant (p=0.001).

Conclusions: The available evidence indicates that there is a significant relationship between low VD3 levels and CRSwNP phenotype. Lower 25VD3 levels were associated with more severe mucosal inflammation on nasal endocscoy and CT scan.


Keywords


Chronic rhinosinusitis, Vitamin D3, Lund-Mackay score, Nasal polyposis, Enzyme linked immunosorbent assay

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References


Fokkens WJ, Lund VJ, Mullol J, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinol Suppl 3p preceding table of contents. 2012; (23):1–298.

Lanza DC, Kennedy DW. Adult rhinosinusitis defined. Otolaryngology–Head and Neck Surgery. 1997;117(3_suppl):S1-7.

Hassan A. Al-Ebiary, Amr G. Shafic et al. Role of vitamin D in chronic rhinosinusitis: a systematic review and meta-analysis study. The Egyptian Journal of Otolaryngology. 2018,34:1-8.

Kern RC, Conley DB, Walsh W, Chandra R, Kato A, Tripathi-Peters A et al. Perspectives on the etiology of chronic rhinosinusitis: an immune barrier hypothesis. American journal of rhinology. 2008;22(6):549-59.

Ali Faghih Habibi, Hooshang Gerami et al. Serum 25-Hydroxy Vitamin D in Chronic Rhinosinusitis with and Without Nasal Polyposis: A Case-Control Study. Iranian Journal of Otorhinolaryngology. 2019; 31(1): 102.

Dobnig H, Pilz S, Scharnagi H, et al. Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med.2008; 168: 1340–1349.

Hewison M. Vitamin D and innate immunity. Curr Opin Investig Drugs. 2008; 9:485–490.

Brehm JM, Celedon JC, Soto-Quiros ME, Avila L, Hunninghake GM, Forno E, et al. Serum vitamin D levels and markers of severity of childhood asthma in Costa Rica. Am J Respir Crit Care Med 2009;179:765–771.

Abuzeid WM, Akbar NA, and Zacharek MA. Vitamin D and chronic rhinitis. Curr Opin Allergy Clin Immunol.2012; 12:13–17.

Mora JR, Iwata M, and von Andrian UH. Vitamin effects on the immune system: Vitamins A and D take centre stage. Nat Rev Immunol. 2008; 8:685–698.

Sultan B, Ramanathan M Jr, Lee J, et al. Sinonasal epithelial cells synthesize active vitamin D, augmenting host innate immune function. Int Forum Allergy Rhinol.2013; 3:26–30.

Kamen DL, and Tangpricha V. Vitamin D and molecular actions on the immune system: Modulation of innate and autoimmunity. J Mol Med (Berl).2010; 88:441–450.

Utiger RD. The need for more vitamin D. N Engl J Med. 1998; 338: 828–829.

Chen Y, Dales R, and Lin M. The epidemiology of chronic rhinosinusitis in Canadians. Laryngoscope 113:1199–1205, 2003.

Van Zele T, Claeys S, Gevaert P, et al. Differentiation of chronic sinus diseases by measurement of inflammatory mediators. Allergy 61: 1280–1289, 2006.

Jiang XD, Li GY, Li L, et al. The characterization of IL-17A expression in patients with chronic rhinosinusitis with nasal polyps. Am J Rhinol Allergy 25:e171–e175, 2011.

Mathieu Adorini L. The coming of age of 1,25-dihydroxyvitamin D(3) analogs as immunomodulatory agents. Trends Mol Med.2002; 8: 174-179.

Adorini L. Immunomodulatory effects of vitamin D receptor ligands in autoimmune diseases. Int Immunopharmacol. 2002; 2: 1017-1028.

Cantorna MT, Hayes CE, DeLuca HF .1,25- Dihydroxycholecalciferol inhibits the progression of arthritis in murine models of human arthritis. J Nutr.1998; 128: 68-72.

Pinto JM, Schneider J, Perez R, DeTineo M, Baroody FM, et al. Serum 25-hydroxyvitamin D levels are lower in urban African American subjects with chronic rhinosinusitis. Allergy Clin Immunol.2008; 122: 415-417.

Arash Shahangia, Rodney J. Schlosser. Role of Vitamin D in Pathogenesis of Chronic Sinusitis with Nasal Polyposis. Adv Otorhinolaryngol. Basel, Karger. 2016; 79:86–90.

Wang LF, Lee CH, Chien CY, Chen JYF, Chiang FY, et al. Serum 25-hydroxyvitamin D levels are lower in chronic rhinosinusitis with nasal polyposis and are correlated with disease severity in Taiwanese patients. Am JRhinol Allergy.2013; 27: e162–e165.

Mulligan JK, Nagel W, O’Connell BP, et al. Cigarette smoke exposure is associated with vitamin D3 deficiencies in patients with chronic rhinosinusitis. J Allergy Clin Immunol.2014 134:342–349.

Sansoni ER, Sautter NB, and Mace JC. Vitamin D3 as a novel regulator of basic fibroblast growth factor in chronic rhinosinusitis with nasal polyposis. Int Forum Allergy Rhinol.2015; 5:191–196.

Sedhagat AR, Gray ST, Caradonna SD, Caradonna DS. Clustering of chronic rhinosinusitis symptomatology reveals novel associations with objective clinical and demographic characteristics. Am J Rhinol Allergy.2015;29(2):100-5.

Srivastava, M., Tyagi, S. & Kumar, L. Comparative Evaluation of Chronic Rhinosinusitis Patients by Conventional Radiography, Computed Tomography and Diagnostic Nasal Endoscopy (DNE) Indian J Otolaryngol Head Neck Surg.2016; 68:173.

Mostafa BED, Taha MS, Hamid TA, Omran A, Lotfi M. Evaluation of vitamin D levels in allergic fungal sinusitis, chronic rhinosinusitis, and chronic rhinosinusitis with polyposis. International Forum of Allergy & Rhinology.2016; 6:2.

Konstantinidis L, Fotoulaki M, Iakovou L, Chatziavramidis A, Mpalaris V, Shobat S, et al. Vitamin D3 deficiency and its association with nasal polyposis in patients with cystic fibrosis and patients with chronic rhinosinusitis. Am J Rhinol Allergy.2017;31:395–400.

Schlosser RJ, Soler ZM, Schmedes GW, Storck K, Mulligan JK. Impact of vitamin D deficiency upon clinical presentation in nasal polyposis. Int Forum Allergy Rhinol. 2014; 4:196–199.

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