The impact of total immunoglobulin E levels on outcomes of maximal medical therapy for chronic rhinosinusitis

Comprehensive evaluation of type 2 endotype and clinical features in patients with chronic rhinosinusitis with nasal polyps in Taiwan: a cross-sectional study

PURPOSE

Endotype-driven treatment has been introduced in the management of chronic rhinosinusitis with nasal polyps (CRSwNP), and an understanding of the associations between phenotypes and endotypes of CRSwNP will be beneficial in identifying responders. We aimed to determine the correlations between clinical manifestations and type 2 inflammatory mediators of sinonasal tissues.

METHODS

Adult patients undergoing endoscopic sinus surgery for bilateral CRSwNP were prospectively enrolled. Tissue eosinophilia and type 2 mediator expression in tissue homogenates were assessed and correlated with clinical features, including symptoms, comorbidities, blood eosinophil counts, specific allergen immunoglobulin (IgE) testing, computed tomography (CT) scan findings, and Sino-Nasal Outcome Test-22 scores.

RESULTS

A total of 93 subjects were recruited in our study. Fifty-nine (63.4%) cases were identified as the eosinophilic endotype, demonstrating with higher rates of comorbidity of asthma, blood eosinophilia and a high ethmoid-maxillary ratio on CT images. To correlate of phenotypes with the inflammatory mediator profile, multivariate analyses revealed the associations of IgE expression in nasal polyp tissues with allergen sensitization (p = 0.042), CT ethmoid-maxillary ratio (p = 0.001) and tissue eosinophil counts (p = 0.022); the association of interleukin (IL-5) expression with the blood eosinophil percentage (p = 0.020); and the association of IL-13 expression with white blood cell count (p = 0.002) and central compartment-type inflammation (p < 0.001).

CONCLUSION

We demonstrated associations of IgE and IL-5 expression with clinical features of eosinophilic-type inflammation and a significantly elevated level of IL-13 in patients with central-compartment-type CRSwNP. These observations may be useful when considering the use of type 2 biologic treatment and require further validation studies.

Assessment of the effect of inflammatory changes and allergic reaction on TAS2R38 receptor expression in patients with chronic sinusitis (CRS)

&lt;b&gt;Background:&lt;/b&gt; Chronic rhinosinusitis (CRS) is one of the most common health complaints affecting 15% of the world's population. Recent reports confirm the participation of sensory organs in the defense process against pathogenic microorganisms. The bitter taste receptor TAS2R38 is described to play a role in the upper airway defense system. &lt;br&gt;&lt;b&gt;Purpose:&lt;/b&gt; The purpose of this study was to assess the function of the bitter taste receptor in correlation with the severity of CRS, sensory organ disorders and allergic reaction. &lt;br&gt;&lt;b&gt;Material and method: &lt;/b&gt;The study contained 100 patients undergoing nasal surgery, divided into two groups: CRS with and without nasal polyps. The control group consisted of patients undergoing septoplasty after excluding rhinosinusitis. Sinus mucosa samples obtained during surgery were used to assess TAS2R38 expression using immunohistochemistry. The IgE level was indicated from blood samples collected from patients. The Sniffin' Sticks Test was performed. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; CRS patients had higher expression of TAS2R38 receptor compared to controls (p = 0.0175). A statistically significantly higher TAS2R38 H-score in nasal mucosa was found among patients with a higher inflammation process in CT scan (p = 0.001), higher IgE level (p = 0,04) and an abnormal result of the Sniffin' Sticks Test. &lt;br&gt;&lt;b&gt;Conclusions: &lt;/b&gt;Patients with CRS had significant TAS2R38 receptor overexpression correlating with the severity of inflammatory changes in CT scans, abnormal perception of smells and higher IgE level. A cumulative impact was found between the inflammatory changes, smell disfunction and the severity of subjective symptoms of CRS (according to EPOS) and the intensity of cell staining (index H-score).