IGHE and chronic rhinosinusitis: Some authors believe that AAPOX develops from an atopic etiology, as it is associated with chronic rhinosinusitis, nasal polyps, elevated IgE, and eosinophilic infiltration of periorbital tissue.1, 2, 3,6 Alternatively, the accumulation of histiocytes in periorbital tissue may be linked to activation of the mononuclear phagocytic system via dendritic cells in the airway epithelium and submucosa.2