Are atopy and eosinophilic bronchial inflammation associated with relapsing forms of chronic rhinosinusitis with nasal polyps?

被引：15

作者：

Yacoub M.-R. ^{[1
,2
]}

Trimarchi M. ^{[1
,2
]}

Cremona G. ^{[1
,2
]}

Dal Farra S. ^{[1
,2
]}

Ramirez G.A. ^{[1
,2
]}

Canti V. ^{[1
,2
]}

Della Torre E. ^{[1
,2
]}

Baldini M. ^{[1
,2
]}

Pignatti P. ^{[3
]}

Bussi M. ^{[1
,2
]}

Sabbadini M.G. ^{[1
,2
]}

Manfredi A.A. ^{[1
,2
]}

Colombo G. ^{[1
,2
]}

机构：

[1] IRCCS San Raffaele Hospital, Allergy and Clinical Immunology Unit, Via Olgettina 60, Milan

[2] Vita-Salute San Raffaele University, Milan

[3] Allergy and Immunology Unit, Fondazione Salvatore Maugeri, IRCCS, Pavia

来源：

Clinical and Molecular Allergy | / 13卷 / 1期

关键词：

Atopy; Eosinophils; Nasal polyps; Relapse; Rhinosinusitis;

D O I：

10.1186/s12948-015-0026-8

中图分类号：

学科分类号：

摘要：

Background: The aetiopathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP) is still unknown. The role of atopy and the concept of united airways in such patients are still a matter of debate. In this pilot study we aimed at evaluating the degree of eosinophilic inflammation and the frequency of atopy in a cohort of CRSwNP patients candidate for Functional Endoscopic Sinus Surgery (FESS) and assessing the association between these factors and relapsing forms of CRSwNP. Methods: 30 patients (18 men, 12 women) with CRSwNP eligible for FESS were evaluated before and after surgery. Preoperative investigation included: history of previous relapse after FESS, clinical and laboratory allergologic assessment, spirometry, methacholine challenge, blood eosinophilia and determination of the fraction of nitric oxide in exhaled air (FeNO). Nasal fibroendoscopy, spirometry and FeNO determination were also assessed prospectively at 3 and 27months post-FESS. Results: 18/30 subjects were atopic, 6/18 (33%) were monosensitized, 16/30 (53%) were asthmatics and 10/30 (33%) had non steroidalantinflammatory drugs (NSAIDs) hypersensitivity. Twenty-one patients (70%) were classified as relapsers, 15/18 (83%) among atopics, 6/12 (50%) among non atopics (p=0.05). Among patients with NSAIDs hypersensitivity, 9/10 (90%) were relapsers. The median IgE concentration was 161.5UI/mL in relapsers and 79UI/mL in non-relapsers (ns). The mean FeNO decreased after FESS (43.1-26.6ppb) in 84% of patients, but this effect disappeared over time (FeNO=37.7ppb at 27months). Higher levels of FeNO pre-FESS were detected in atopics, and in particular in relapsing ones (median 51.1ppb vs 22.1, ns). Higher levels of FeNO pre-FESS were detected in asthmatic patients, especially in those who relapsed (median: 67 vs 64.85ppb in non-relapsed patients, ns). The Tiffeneau Index (FEV1/FVC) was significantly lower in asthmatic relapsers than in non relapsers asthmatics (94.7±11.1 versus 105±5.9-p=0.04). Patients with asthma and atopy had a major risk of relapse (p=0.05). Conclusion: In our pilot study, atopy, severe asthma, bronchial inflammation, NSAIDs hypersensitivity and high level of total IgE are possible useful prognostic factors for the proneness to relapse after FESS. The role of allergy in CRSwNP pathogenesis should consequently be given deeper consideration. Allergen specific immunotherapy, combined with anti-IgE therapy, may have an immunomodulatory effect preventing polyps relapse and need to be investigated. © 2015 Yacoub et al.

引用

共 32 条

[1]

Fokkens W.J., Lund V.J., Mullol J., Bachert C., Alobid I., Baroody F., Et al., European position paper on rhinosinusitis and nasal polyps 2012, pp. 1-298, (2012)

[2]

Collins J.G., Prevalence of selected chronic conditions: United States, 1990-1992, Vital Health Stat Ser 10 Data Natl Health Surv, 194, pp. 1-89, (1997)

[3]

Pilan R.R., Pinna F.R., Bezerra T.F., Mori R.L., Padua F.G., Bento R.F., Et al., Prevalence of chronic rhinosinusitis in Sao Paulo, Rhinology, 50, 2, pp. 129-138, (2012)

[4]

Johansson L., Akerlund A., Holmberg K., Melen I., Bende M., Prevalence of nasal polyps in adults: the Skovde population-based study, Ann Otol Rhinol Laryngol, 112, 7, pp. 625-629, (2003)

[5]

Larsen K., Tos M., The estimated incidence of symptomatic nasal polyps, Acta Otolaryngol, 122, 2, pp. 179-182, (2002)

[6]

Drake-Lee A.B., Lowe D., Swanston A., Grace A., Clinical profile and recurrence of nasal polyps, J Laryngol Otoltol, 98, 8, pp. 783-793, (1984)

[7]

Moloney J.R., Nasal polyps, nasal polypectomy, asthma, and aspirin sensitivity. Their association in 445 cases of nasal polyps, J laryngolOtol, 91, 10, pp. 837-846, (1977)

[8]

Larsen K., Tos M., Clinical course of patients with primary nasal polyps, Acta Otolaryngol, 114, 5, pp. 556-559, (1994)

[9]

Settipane G.A., Epidemiology of nasal polyps, Allergy Asthma Proc, 17, 5, pp. 231-236, (1996)

[10]

Fruth K., Goebel G., Koutsimpelas D., Gosepath J., Schmidtmann I., Mann W.J., Et al., Low SPINK5 expression in chronic rhinosinusitis, Laryngoscope, 122, 6, pp. 1198-1204, (2012)

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