The Association of Total IgE and Specific IgE Anti-Staphylococcal Enterotoxin with Chronic Hyperplastic Rhinosinusitis

RATIONALE: Staphylococcal enterotoxins (SE) have been implicated in the pathogenesis of nasal polyposis in chronic hyperplastic rhinosinusitis (CHRS). It is thought they act as superantigens and provide stimulation for an ongoing inflammatory process. We hypothesized that IgE antibodies to SE (anti-SE) would be present in a high percentage of CHRS patients.METHODS: Sixty-seven patients with nasal polyps were enrolled and subdivided into four groups: allergic fungal sinusitis (AFS), eosinophilic mucin rhinosinusitis (EMRS), Samter's triad without AFS or EMRS (SAM), and chronic sinusitis with none of the previous 3 conditions (CHS). Serum total IgE and specific IgE against staphylococcal enterotoxins A, B, C, D and toxic shock syndrome toxin-1 were determined by UniCAP 100 fluoroenzymeimmunoassay.RESULTS: Total IgE ranges for AFS, EMRS, SAM, and CHS were 28-6740, 13-1948, 46-400, and 25-954 IU/ml, respectively. Number of positive IgE anti-SE ranged from 0-5 in AFS, 0-5 in EMRS, 0-1 in SAM, and 0-2 in CHS. There was a significant association (p1000 IU/ml and IgE to 3 or more SE (≥3SE). Only AFS and EMRS had total IgE >1000 IU/ml and all patients with IgE >1000 IU/ml had anti-SE to ≥3SE.CONCLUSIONS: Anti-SE was found to at least 1 SE in 49% of CHRS patients, but IgE anti-SE to ≥3SE was found only in AFS and EMRS patients. Since a statistically significant association exists between the presence of anti-SE to ≥3SE and total IgE >1000 IU/ml, it is likely that IgE anti-SE antibodies contribute to the elevation of total IgE in these patients. RATIONALE: Staphylococcal enterotoxins (SE) have been implicated in the pathogenesis of nasal polyposis in chronic hyperplastic rhinosinusitis (CHRS). It is thought they act as superantigens and provide stimulation for an ongoing inflammatory process. We hypothesized that IgE antibodies to SE (anti-SE) would be present in a high percentage of CHRS patients. METHODS: Sixty-seven patients with nasal polyps were enrolled and subdivided into four groups: allergic fungal sinusitis (AFS), eosinophilic mucin rhinosinusitis (EMRS), Samter's triad without AFS or EMRS (SAM), and chronic sinusitis with none of the previous 3 conditions (CHS). Serum total IgE and specific IgE against staphylococcal enterotoxins A, B, C, D and toxic shock syndrome toxin-1 were determined by UniCAP 100 fluoroenzymeimmunoassay. RESULTS: Total IgE ranges for AFS, EMRS, SAM, and CHS were 28-6740, 13-1948, 46-400, and 25-954 IU/ml, respectively. Number of positive IgE anti-SE ranged from 0-5 in AFS, 0-5 in EMRS, 0-1 in SAM, and 0-2 in CHS. There was a significant association (p1000 IU/ml and IgE to 3 or more SE (≥3SE). Only AFS and EMRS had total IgE >1000 IU/ml and all patients with IgE >1000 IU/ml had anti-SE to ≥3SE. CONCLUSIONS: Anti-SE was found to at least 1 SE in 49% of CHRS patients, but IgE anti-SE to ≥3SE was found only in AFS and EMRS patients. Since a statistically significant association exists between the presence of anti-SE to ≥3SE and total IgE >1000 IU/ml, it is likely that IgE anti-SE antibodies contribute to the elevation of total IgE in these patients.