Upper Airways Research Laboratory, Ghent University, Ghent, Belgium; Division of ENT Diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden.
Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
J Allergy Clin Immunol. 2021 Jun;147(6):1997-2008. doi: 10.1016/j.jaci.2021.03.016. Epub 2021 Mar 20.
Taking a novel approach, this narrative review collates knowledge about nasal polyposis and the biological functions of IgE in several diseases (allergic rhinitis, allergic asthma, nonsteroidal anti-inflammatory drugs-exacerbated respiratory disease, and chronic spontaneous urticaria) to consider which IgE-mediated mechanisms are relevant to nasal polyposis pathology. A type 2 eosinophil-dominated inflammatory signature is typical in nasal polyp tissue of European patients with nasal polyposis, with a shift toward this endotype observed in Asian populations in recent years. Elevated polyclonal IgE is present in the nasal tissue of patients with and without allergy. It is derived from many different B-cell clones and, importantly, is functional (proinflammatory). Staphylococcus aureus enterotoxins are thought to act as superantigens, inducing production of polyclonal IgE via B-cell and T-cell activation, and triggering release of inflammatory mediators. In some patients, exposure to antigens/triggers leads to production of high levels of antigen-specific IgE, which mediates cross-linking of the high-affinity IgE receptor on various cells, causing release of inflammatory mediators. The efficacy of omalizumab confirms IgE as an important inflammatory mediator in nasal polyposis. By blocking IgE, omalizumab targets the T2 inflammation in nasal polyposis, reduces nasal polyp score and improves symptoms.
采取一种新颖的方法，本综述将关于鼻息肉和 IgE 在几种疾病（变应性鼻炎、变应性哮喘、非甾体抗炎药加重的呼吸系统疾病和慢性自发性荨麻疹）中的生物学功能的知识进行了整理，以探讨哪些 IgE 介导的机制与鼻息肉病理相关。欧洲鼻息肉患者的鼻息肉组织中存在典型的 2 型嗜酸性粒细胞为主的炎症特征，近年来亚洲人群中观察到这种表型向该表型的转变。患有和不患有过敏症的患者的鼻组织中均存在升高的多克隆 IgE。它来源于许多不同的 B 细胞克隆，重要的是，它是有功能的（促炎）。金黄色葡萄球菌肠毒素被认为作为超抗原起作用，通过 B 细胞和 T 细胞的激活诱导多克隆 IgE 的产生，并触发炎症介质的释放。在一些患者中，暴露于抗原/触发物会导致产生高水平的抗原特异性 IgE，该 IgE 介导各种细胞上高亲和力 IgE 受体的交联，导致炎症介质的释放。奥马珠单抗的疗效证实了 IgE 作为鼻息肉中一种重要的炎症介质。通过阻断 IgE，奥马珠单抗靶向鼻息肉中的 T2 炎症，降低鼻息肉评分并改善症状。
