Total and Antigen- (Fungi, Mites and Staphylococcal Enterotoxins) Specific IgEs in Nasal Polyps Is Related to Local Eosinophilic Inflammation

Abstract

Background: Total and specific immunoglobulin E (IgE) in nasal polyps (NP) is related to local eosinophilic inflammation. However, it remains unclear which antigens cause a stronger accumulation of eosinophils in NP. We investigated whether local IgEs to specific antigens correlated with local eosinophil accumulation. Methods: Total IgE, antigen-specific IgEs [5 species of fungi, staphylococcal enterotoxins A and B (SEA and SEB), cedar pollen, ragweed pollen and house-dust mites] and eosinophil cationic protein (ECP) were measured in sinus mucosa homogenates and serum from 29 patients with chronic rhinosinusitis with NP (CRSwNP), 8 patients with allergic fungal rhinosinusitis (AFRS) and 8 control subjects without CRS. The level of ECP in NP was analyzed for correlations with the total and specific IgE levels in the serum and NP. Results: In CRSwNP, antigen-specific IgEs [Alternaria > mite (Dp) > Aspergillus > SEB > Penicillium > mite (Df), but not the other fungi, SEA or pollens] in the sinus mucosa correlated significantly with the local ECP.In AFRS, antigen-specific IgEs [Penicillium > mite (Df) > Alternaria, but not the other fungi, SEs or pollens] in the sinus mucosa correlated significantly with the local ECP. Conclusions: Local total IgE and antigen (fungi, mites and SEs)-specific IgEs in NP are related to the local eosinophilic inflammation of AFRS and CRSwNP.

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…The locally formed IgE is polyclonal, with IgE antibodies against several hundred or more allergens, and functional, even in the absence of systemic IgE antibodies or a positive skin-prick test. 916,917 Among those IgE specificities, only staphylococcal enterotoxins have superantigenic activity. CRSwNP showed a significantly higher S. aureus culture-positivity and a higher detection rate of S. aureus superantigens and of specific SE-IgE in a recent meta-analysis.…”

“…AFRS patients have elevated serum total and fungal-specific IgE compared to CRSwNP patients, and serum-specific IgE levels (to both fungal and nonfungal allergens) have been shown to correlate with clinical severity and recurrence. 917,1073,1074,1077,1081,1082 Eosinophilic mucin, which is not present in all forms of CRSwNP, is a byproduct of inflammation and contributes to disease persistence or progression. Eosinophilic mucin characteristic of AFRS is thick, tenacious, and consists of necrotic and degranulating eosinophils in a background of mucin, Charcot-Leyden crystals, and fungal hyphae.…”

“…1086 Various studies demonstrate elevation of fungal and nonfungal IgE within AFRS mucosa, and local IgE correlates with sinonasal eosinophilia. 917,1079,1080,1093,1099,1100 Most AFRS patients also have detectable fungal-specific IgE in their mucin. 1077 AFRS is a distinct, often more severe, subclass of CRSwNP.…”

The Intervention of CRAC Channels Alleviates Inflammatory Responses in Nasal Polyps

“…Regarding IgE-mediated NP generation, there have been a few studies demonstrating increased production of IgE within NP tissues [23,24]. Other studies have further shown that DP-sIgE can stimulate eosinophil recruitment and degranulation, resulting in the release of cytotoxic proteins such as ECP and eosinophil peroxidase in in vitro conditions and in NP [25,26].…”

Allergogenic Profile in Patients with Different Subtypes of Chronic Rhinosinusitis with Nasal Polyps

“…Previous studies reported that there were obvious differences in clinical manifestations between eosinophilic and noneosinophilic inflammation [10,11,12]. Therefore, different managements based on the phenotyping of CRSwNP [eosinophilic nasal polyps (ENP) and noneosinophilic nasal polyps (nENP)] are necessary to ultimately improve the outcome [7,13]. …”