Central Compartment Atopic Disease: Analysis of Current Literature and Proposal of Diagnostic Criteria

ABSTRACT Background Central compartment atopic disease (CCAD) is a nasal inflammatory condition associated with allergy and categorized as type 2 dominant chronic rhinosinusitis with nasal polyps (CRSwNP). Sinus opacification in this condition is secondary to obstruction from central tissue remodeling. Although the literature supports a unique phenotype of CCAD, controversy persists due to variations in published studies. Standardized diagnostic criteria for CCAD are lacking. The current literature was systematically evaluated to propose a set of diagnostic criteria for CCAD. Methods A comprehensive literature review on CCAD was performed. Using current knowledge as the foundation, diagnostic criteria for CCAD are proposed. Results Tissue remodeling of the central part of the nasal and sinus cavity in a patient with features of an IgE mediated allergic process is the cornerstone of CCAD. It is a type 2 dominant endotype with an eosinophilic inflammatory profile. While CCAD is represented by unique phenotypic and endotypic features, there are likely geographic variations in CCAD presentation, especially when comparing CCAD to other subtypes of CRS. Previous lack of clear diagnostic criteria for CCAD has likely contributed to conflicting findings in the published literature on CCAD. Conclusion Endoscopic confirmation of polypoid changes of central compartment structures (middle/superior turbinate, and/or posterosuperior nasal septum) is critical to the diagnosis of CCAD. Allergic history strongly supports CCAD diagnosis. While CCAD may display some unique radiologic features, radiology alone is insufficient to diagnose CCAD.