The two most common predisposing conditions to developing sinusitis are viral upper respiratory tract infections and allergic rhinitis. Allergic rhinitis is one of the most common chronic diseases, affecting up to 35.9 million Americans annually.

The diagnosis of sinusitis is based on a combination of clinical history, physical examination, imaging studies, and/or laboratory tests. The Diagnosis and Management of Sinusitis: A Practice Parameter Update recommends:

• The diagnosis of acute sinusitis should be primarily based on the history and physical examination of the patient. Imaging techniques such as radiographs or CT scans are not necessary.
• Antibiotics should be withheld for 10 to 14 days, unless severe symptoms develop such as fever, facial pain or tenderness, or swelling around the eye.
• The primary therapy for acute bacterial sinusitis is antibiotics, but with increasing resistance to penicillin being reported, alternative antibiotics may be necessary.
• Referral to an allergist/immunologist, particularly for patients with chronic or recurrent sinusitis associated with certain conditions, and in patients who have undergone prior surgical procedures and continue to experience sinusitis.
• Surgery is a consideration only after medical therapy has failed.

According to the practice parameter and the AAAAI, referral to an allergist/immunologist should be sought when:

• The patient suffers chronic, recurrent infectious or fungal rhinosinusitis.
• There is a need to clarify whether an allergic or immune deficiency co
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