Department of Otolaryngology-Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.
J Otolaryngol Head Neck Surg. 2010 Feb;39(1):45-51.
Chronic rhinosinusitis with nasal polyposis (CRSwNP) represents an eosinophilic T-helper 2 inflammatory response. Local production of IgE within nasal polyps (NPs) has been demonstrated, suggesting a role for local IgE in the pathogenesis of NP in atopic CRS patients. We hypothesized that local IgE specific to inhalant allergens may also play a role in the genesis of NP in nonatopic CRS patients.
Sinus and inferior turbinate tissue was obtained from nonatopic CRSwNP patients (n = 7), chronic rhinosinusitis without nasal polyps (CRSsNP) patients (n = 15), and healthy controls (n = 9) at the time of surgery. ImmunoCAP analysis (Phadia AB, Portage, MI) for 14 common inhalant antigens was performed on tissue homogenates to determine the antigen-specific response.
Total IgE levels did not differ in sinus or turbinate tissue between CRSwNP, CRSsNP, or control patients. CRSwNP sinus tissue had higher levels of specific IgE for cockroach and plantain (p = .03) than other groups and elevated Alternaria IgE levels when compared with CRSsNP sinus tissue (p < .05). No significant differences were found for any of the other antigen-specific IgE levels. Fifty-seven percent of CRSwNP polyps demonstrated a polyclonal IgE response, whereas the other 43% had no demonstrable antigen-specific IgE. In contrast, only 17% of CRSsNP patients demonstrated a polyclonal response within sinus tissue, whereas 67% had no detectable antigen-specific IgE. There was no significant difference in levels of IgE in inferior turbinate tissue between the groups (p > .05).
Localized mucosal IgE specific to common inhalant allergens appears to play a role in a subset of CRSwNP patients without evidence of systemic atopy.
伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）表现为嗜酸性 Th2 炎症反应。已证实鼻息肉（NPs）内局部产生 IgE，提示局部 IgE 可能在特应性 CRS 患者的 NP 发病机制中发挥作用。我们假设针对吸入性过敏原的局部 IgE 也可能在非特应性 CRS 患者 NP 的发生中起作用。
在手术时，从非特应性 CRSwNP 患者（n=7）、慢性鼻-鼻窦炎伴鼻息肉（CRSsNP）患者（n=15）和健康对照者（n=9）中获取鼻窦和下鼻甲组织。对组织匀浆进行 14 种常见吸入性抗原的 ImmunoCAP 分析（Phadia AB，Portage，MI），以确定抗原特异性反应。
CRSwNP、CRSsNP 或对照患者的鼻窦或鼻甲组织中的总 IgE 水平没有差异。CRSwNP 鼻窦组织中对蟑螂和车前草的特异性 IgE 水平高于其他组（p=0.03），与 CRSsNP 鼻窦组织相比，其 Alternaria IgE 水平升高（p<0.05）。其他任何抗原特异性 IgE 水平均无显著差异。57%的 CRSwNP 息肉表现出多克隆 IgE 反应，而其余 43%则无可检测到的抗原特异性 IgE。相比之下，仅有 17%的 CRSsNP 患者在鼻窦组织中表现出多克隆反应，而 67%则未检测到抗原特异性 IgE。各组之间下鼻甲组织中的 IgE 水平无显著差异（p>0.05）。
针对常见吸入性过敏原的局部黏膜 IgE 似乎在无全身特应性证据的一部分 CRSwNP 患者中起作用。
