From the Guidelines
A workup should be considered for a patient with recurrent Upper Respiratory Infections (URIs) to identify underlying conditions that may require specific treatment, as recurrent URIs may indicate immunodeficiency, anatomical abnormality, or chronic inflammatory condition. The most recent and highest quality study, 1, suggests that clinical guidelines recommend using clinical signs and symptoms to differentiate bacterial from viral causes, and a bacterial cause is more likely when symptoms persist for more than 10 days without clinical improvement.
Initial Evaluation
Initial evaluation should include:
- A thorough history and physical examination, focusing on potential risk factors such as allergies, environmental exposures, or underlying conditions
- Basic laboratory tests including complete blood count with differential, comprehensive metabolic panel, and possibly immunoglobulin levels (IgA, IgG, IgM, IgE) Additional testing may include:
- Sinus imaging if sinusitis is suspected
- Pulmonary function tests if asthma is a concern
- Allergy testing if allergic triggers are suspected
- HIV testing may be appropriate in some cases
Management
Management might include:
- Addressing modifiable risk factors
- Treating underlying conditions
- In some cases, prophylactic antibiotics or immunoglobulin replacement therapy depending on the findings As stated in 1, clinicians should distinguish CRS and recurrent ARS from isolated episodes of ABRS and other causes of sinonasal symptoms, and confirm a clinical diagnosis of CRS with objective documentation of sinonasal inflammation.
Underlying Conditions
Recurrent URIs may indicate underlying conditions such as:
- Immunodeficiency
- Anatomical abnormality
- Chronic inflammatory condition Early identification of these underlying causes can lead to targeted interventions that reduce infection frequency and prevent complications, as suggested in 1.
From the Research
Workup for Recurrent Upper Respiratory Infections (URIs)
- Recurrent URIs can be caused by various factors, including viral or bacterial infections, and may require a thorough workup to determine the underlying cause 2, 3.
- In some cases, patients with recurrent URIs may have underlying immunoglobulin deficiencies, which can increase their susceptibility to infections 4, 5.
- A study published in 2020 found that inhaled nebulized immunoglobulin (INHIG) can reduce the number of URTI episodes in patients with antibody deficiencies 4.
- Another study published in 2015 found that immunoglobulin deficiency is a frequent condition in patients with chronic rhinosinusitis (CRS), and recommended immunoglobulin titers and accurate allergy diagnostic workups to provide specific treatments for symptom alleviation 5.
- Physicians should recognize the symptoms consistent with bacterial pharyngitis, infectious mononucleosis, and sinusitis to provide appropriate diagnostic testing, treatment, and return-to-play recommendations 6.
- A workup for recurrent URIs may include diagnostic testing, such as blood work or imaging studies, to rule out underlying conditions that may be contributing to the recurrent infections 2, 3.