Muluk Nuray Bayar, Altın Fazilet, Cingi Cemal
1 Department of Otorhinolaryngology, Medical Faculty, Kirikkale University, Kirikkale, Turkey.
2 ENT Clinics, Haseki Training and Research Hospital, Istanbul, Turkey.
Am J Rhinol Allergy. 2018 Nov;32(6):502-517. doi: 10.1177/1945892418801083. Epub 2018 Sep 25.
Our intention was to review all material published to date regarding superantigens (SAgs) and allergy from an otorhinolaryngological viewpoint to understand this association more clearly.
We identified all materials published mentioning both SAg and allergic rhinitis (AR), chronic sinusitis, asthma, and atopic dermatitis (AD) that are indexed on PubMed, Google, or the ProQuest Central databases.
Staphylococcus aureus is a significant bacterial pathogen in humans and has the ability to produce enterotoxins with superantigenic features. The inflammatory response in allergy seen in both B cell and T cell may be attributed to SAgs. Sufferers of both allergic asthma with rhinitis and AR alone produce serological evidence of immunoglobulin E formation to SAgs produced by S. aureus. Perennial AR sufferers carry S. aureus more frequently and the presence of the organism within the nasal cavity may exacerbate perennial AR. SAg produced by S. aureus potentially worsens the asthmatic inflammatory response within the airway and may lead to the airways becoming hyperresponsive, as well as possibly activating T cells if asthmatic control is poor. Staphylococcal SAgs potentially increase the risk of developing chronic rhinosinusitis with nasal polyposis, additionally being a marker for more severe disease. If SAgs bring about chronic inflammatory responses in the nose and sinuses, then T cells excreting interferon-gamma may be a crucial mediator. In allergic dermatitis, S. aureus could be a key player in exacerbation of the condition. Even in younger pediatric patients with allergic dermatitis, allergic hypersensitivity to SAgs is frequent and may be a factor explaining how severe the condition becomes.
Just as SAgs are known to feature in many allergic conditions, they play their part in AR, chronic rhinosinusitis, asthma, and AD. Further research is required before the relationship between SAgs and allergy can be adequately explained.
我们旨在从耳鼻咽喉科的角度回顾迄今为止发表的所有关于超抗原（SAgs）与过敏的资料，以更清楚地了解这种关联。
我们在PubMed、谷歌或ProQuest Central数据库中检索了所有提及SAgs以及变应性鼻炎（AR）、慢性鼻窦炎、哮喘和特应性皮炎（AD）的已发表资料。
金黄色葡萄球菌是人类重要的细菌病原体，能够产生具有超抗原特性的肠毒素。在过敏反应中，B细胞和T细胞出现的炎症反应可能归因于SAgs。患有变应性鼻炎合并哮喘和单纯AR的患者均产生了针对金黄色葡萄球菌产生的SAgs的免疫球蛋白E形成的血清学证据。常年性AR患者携带金黄色葡萄球菌的频率更高，鼻腔内该微生物的存在可能会加重常年性AR。金黄色葡萄球菌产生的SAgs可能会使气道内的哮喘炎症反应恶化，并可能导致气道反应性增高，如果哮喘控制不佳还可能激活T细胞。葡萄球菌SAgs可能会增加患鼻息肉慢性鼻窦炎的风险，此外还是更严重疾病的一个标志物。如果SAgs在鼻腔和鼻窦引发慢性炎症反应，那么分泌γ干扰素的T细胞可能是关键介质。在过敏性皮炎中，金黄色葡萄球菌可能是病情加重的关键因素。即使在患有过敏性皮炎的年幼儿科患者中，对SAgs的过敏性超敏反应也很常见，可能是解释病情严重程度的一个因素。
正如已知SAgs在许多过敏疾病中起作用一样，它们在AR、慢性鼻窦炎、哮喘和AD中也发挥作用。在能够充分解释SAgs与过敏之间的关系之前，还需要进一步研究。
