Upper Airway Research Laboratory, Department of Oto-Rhino-Laryngology, Ghent University Hospital, Ghent, Belgium.
J Intern Med. 2012 Aug;272(2):133-43. doi: 10.1111/j.1365-2796.2012.02559.x.
Chronic rhinosinusitis (CRS) affects more than 10% of the European population and is often associated with asthma. Phenotypes of CRS can be differentiated based on mucosal remodelling and inflammatory patterns. Understanding the role of central mediators, such as interleukin-5, in these different phenotypes may lead to the development of specific therapeutic approaches. The impact of staphylococcal superantigens has been shown to further modify the immune response, contributing to persistent severe disease via the activation of T and B cells and the formation of local IgE. It is clear that these mechanisms are involved in the systemic spread of upper airway disease with resulting asthma comorbidity, when IgE antibodies to staphylococcal enterotoxins are present at measurable levels in serum. Recent findings point to superantigens as possible causal agents in the intrinsic form of severe asthma, and an anti-IgE strategy has shown promising therapeutic potential in nonatopic patients with nasal polyps and asthma. These findings should lead to a clinically relevant endotyping of patients with upper and lower airway disease and to a new understanding of the role of IgE 'above atopy'.
慢性鼻-鼻窦炎（CRS）影响超过 10%的欧洲人口，常与哮喘相关。基于黏膜重塑和炎症模式，CRS 可分为不同表型。了解白细胞介素-5 等中枢介质在这些不同表型中的作用，可能会促使开发出特定的治疗方法。葡萄球菌超抗原的作用已被证明可进一步改变免疫反应，通过 T 细胞和 B 细胞的激活以及局部 IgE 的形成，导致持续性严重疾病。当血清中可测量到针对葡萄球菌肠毒素的 IgE 抗体时，这些机制显然与上呼吸道疾病的全身传播以及由此导致的哮喘合并症有关。最近的研究结果表明，超抗原可能是严重哮喘内在形式的潜在病因，抗 IgE 策略在非特应性伴鼻息肉和哮喘的患者中显示出有前景的治疗潜力。这些发现应导致对上、下呼吸道疾病患者进行临床相关的表型分型，并对 IgE“高于特应性”的作用有新的认识。
