Antigen-Specific IgE Antibody and Cytogram in Mucosa of the Nose and Sinus

Abstract

Maxillary sinus mucosa from sinusitis patients (n = 60) and nasal mucosa from the inferior turbinates ofhypertrophic rhinitis patients (n = 31) were collected to detect the appearance of tissue dust mite-specific IgE antibody and increase in eosinophils, mast cells, and plasma cells. The serum levels of total IgE and dust mite-specific IgE antibody were significantl.v greater in atopic patients than in nonatopic patients, whereas tissue specific IgE antibody was elevated in turbinate mucosa but not in sinus mucosa. Eosinophils and basophilic cells in epithelial scrapings from the inferior turbinates, assessed by Hansel stain, increased in about 85% of atopic patients with hypertrophic rhinitis (n = 16) and 60% of atopic patients with chronic sinusitis (n = 12). The increase in eosinophils, mast cells, and plasma cells was more prevalent in the turbinate mucosa of atopic patients than in that of nonatopics, but there was no such increase in sinus mucosa. We conclude that the maxillary sinuses may not be the target organ of type I allergic reaction and antigen-specific IgE antibody is probably produced by the local lymphoid tissue.Am J Rhinology W ith the improvement of nutrition and medical care, the incidence of chronic sinusitis is gradually decreasing in Taiwan. 1 However, the changed lifestyle and increasingly polluted environment have resulted in more numerous patients with respiratory tract hypersensitivity.2 Earlier studies by Savolainen 3 and van Dishoeck 4 indicate that allergic rhinitis and acute or chronic sinusitis are closely linked. They found that 30-50% of patients with acute sinusitis and 40-67% of patients with chronic sinusitis have a history of nasal allergy. Sinus X-rays reveal abnormality in 50% of nasal-allergic patients. 5 . 6 The question arises whether sinusitis is due to the effect of immediate type allergic reaction occurring in the sinus mucosa by direct contact with inhalant antigens or whether it is secondary to edematous obstruction of the sinus ostium. The purposes of our work were to investigate the role of allergy as an underlying factor in sinusitis and to analyze the relation between the histopathologic changes of sinus and turbinate mucosa and IgE production in nasal allergy. MATERIALS AND METHODSPatient population S ixty patients proved to have chronic sinusitis by the presence of mucopurulent rhinorrhea (with or without nasal polyps) and mucosal changes (mucosa thickening >5 mm or opacification) in sinus X-ray films were selected for surgical intervention. The ages were in the range of 20-50 years. They included 38 men with a mean age of 38.2 years and 22 women with a mean age of 35.5 years. Another 31 patients with 111

Rhinosinusitis: evidence and experience

“…385 , 386 , 387 Contrary to studies that reported atopy as more prevalent in patients with NPs, other authors found no such association. 384 , 387 , 388 , 389 Allergy does not appear to have a direct association with NPs, but can be an aggravating factor.…”