Beyond Borders and Sinuses: Rhinology and Allergy Research on a World Stage

Abstract

Beyond borders and sinuses: Rhinology and allergy research on a world stage R esearch forms the keystone on which medicine is advanced. It improves our understanding of the disease process and paves the way for new treatment development. This journal prides itself on the publishing of well-performed basic science and clinical research. Its adherence to a rigorous peer-review process and the careful selection of diverse articles maintains its high quality and its relevance to the broad readership. This issue, in particular, exemplifies the international presence of American Journal of Rhinology & Allergy (AJRA), with as many articles from abroad as from local research groups. Basic science, translational, and clinical research articles from the United States, Europe, Asia, and the Middle East comprise this installment of the AJRA, with diverse topics to interest both clinicians and scientists. Novel biomarkers for predicting polyps status, topical therapy to improve nasal continuous positive airway pressure (CPAP) compliance, and the use of gels and/or stents to improve surgical outcomes are among the many interesting articles available to the reader.Inflammatory upper airway disorders remain among the most common chronic conditions that confront primary health care providers and otolaryngologists. Most recent estimates indicate that the overall cost of chronic rhinosinusitis (CRS) to the American population exceeds 20 billion dollars per year. 1 Although patients often look to surgery as a "cure" for their condition, most clinicians would agree that the main role of surgery is to reduce the inflammatory burden and improve the access of the sinuses to topical medications. It is not until the complex inflammatory pathways are completely discerned that a "cure" will ever be achievable. An important step forward toward this requires an understanding of the pathophysiology at an immunologic level. The relatively recent discovery of the regulatory T cells and their role in CRS was a significant breakthrough. These cells seem to play a central immunomodulatory role in inflammatory nasal disease and may hold the key to controlling the dysregulated inflammation seen in these conditions.In this issue of the AJRA, Palmer et al., 2 provided a comprehensive review of the role of regulatory T cells in upper airways inflammation and identified current deficiencies in our understanding of their function. Defective cytotoxic T-cell function has similarly also been implicated in the dysregulated immune response seen in CRS. 3 A novel study by Smith et al., 4 also published in this issue, set out to explore the mechanism behind this. In their study of patients with CRS with and without polyps, the investigators observed a decrease in the local production of the important cytotoxic T-cell mediators, granzyme B, and perforin, despite an increase in absolute cytotoxic T-cell numbers in the tissue of patients with CRS. 4 They postulated that it is possible that this deficiency may affect antiviral immunity and predispose patients with ...