Recurrent URIs: Where to Start?
Allergist-immunologists are frequently asked to evaluate patients with recurrent upper respiratory infections (URIs) for immune deficiency. It is very easy to order immune globulin studies but it's often not necessary, and a detailed history can better select for the appropriate patient for that workup. After two decades of practice studying the allergic, immunologic, and endoscopic features of patients with recurrent sinus infections, I have come to understand that there are many mundane explanations beyond antibody deficiency and that a detailed history (as always in medicine) is the best place to start. The most basic thing to consider is whether the "sinus infections," for example, were really bacterial in the first place. Sometimes patients with frequent sinus infections simply have sinus pressure with allergy or colds. You must ask the patient what they mean when they say "sinus infections," how long they wait before seeing a doctor for antibiotics, and what happens if they do not take antibiotics.
Even if the history does indeed suggest recurrent bacterial infections, it's important to remember that the vast majority of these patients do not have immune deficiency, but instead probably have much more mundane explanations. Here is my suggested checklist of the most common triggers of URIs:
