Abstract
Objectives:
For the past few decades, endoscopic sinus surgery (ESS) combined with medication therapy has improved the prognosis of chronic rhinosinusitis with nasal polyps (CRSwNP). However, we sometimes encounter refractory CRSwNP complicated with nonatopic asthma and tremendous eosinophil infiltration in nasal polyps. Recently, enterotoxin of Staphylococcus aureus (S aureus) and fungi have been thought to contribute to the pathology of refractory CRSwNP, while its pathophysiology in detail is still controversial. Aim of study: In order to elucidate the pathology of refractory CRSwNP, antigen-specific IgEs and IgGs to enterotoxin of S. aureus (SAE-A, B) and fungi in ethmoid sinus mucosa, in addition to IgE and IgG analysis in blood serum and skin tests, were studied in operation cases with CRSwNP.
Methods:
Total IgE and IgG and SAE-A, B, Aspergillus, Candida and Alternaria-specific IgEs and IgGs production in ethmoid sinus mucosa were analyzed and compared to such data in blood serum and the results of skin tests in operation cases with CRSwNP in our university hospital. Ethmoid sinus mucosa was obtained during operation and kept in liquid nitrogen followed by mashing in 1 mL phosphate-buffered saline (PBS). After centrifugation of this PBS, the supernatant was harvested in each case to analyze total and antigen-specific IgEs and IgGs based on the weight correction of each sample.
Results and Conclusions:
In the skin tests, positive reaction was often observed only to Candida 48 hours after injection. While local fungi-specific IgEs were little, local SAE-A,-B-specific IgEs were apparently positive and local total IgE level was elevated. Candida specific Ig G and/or SAE-A, -B specific IgE dependent reactions may play important roles in the pathophysiology of refractory CRSwNP.
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