PMID- 15586797
OWN - NLM
STAT- MEDLINE
DCOM- 20050217
LR  - 20220408
IS  - 1050-6586 (Print)
IS  - 1050-6586 (Linking)
VI  - 18
IP  - 5
DP  - 2004 Sep-Oct
TI  - Chronic sinusitis with nasal polyps: staphylococcal exotoxin immunoglobulin E and 
      cellular inflammation.
PG  - 273-8
AB  - BACKGROUND: The etiology of chronic sinusitis with nasal polyposis (CS/NP) 
      remains enigmatic. Frequently, Staphylococcus aureus is present in the nose of 
      CS/NP patients, although the significance is unclear. Recent reports have 
      suggested the hypothesis that these bacteria may secrete exotoxins triggering the 
      inflammatory mucosal changes seen in CS/NP. This mechanism of immunopathology has 
      been established in other diseases associated with Staphylococcus colonization 
      and exotoxin secretion such as atopic dermatitis. In atopic dermatitis, the 
      exotoxins incite a local superantigen response in which clonal T-cell activation 
      and massive cytokine release occur in the affected skin. Second, these exotoxins 
      can act as traditional allergens, stimulating a typical immunoglobulin E (IgE) 
      response in the serum, which has been correlated with disease severity. This 
      study is designed to begin the assessment of the hypothesis that a similar 
      mechanism takes place in CS/NP. METHODS: Serum was drawn from patients with CS/NP 
      undergoing endoscopic sinus surgery as well as 13 atopic and nonatopic control 
      subjects without sinusitis. IgE levels to S. aureus exotoxins A (SEA), SE 
      exotoxins B (SEB), and toxic shock syndrome toxin 1 were measured using 
      enzyme-linked immunosorbent assay. Tissue eosinophilia and the presence of 
      lymphocytes on hemotoxylin and eosin-stained sections of polyps were scored by a 
      blinded pathologist and correlated to presence of toxin IgE in the serum. 
      RESULTS: Staphylococcal exotoxin (SE)-specific IgE was found in the serum of 5/10 
      (50%) of the patients with CS/NP. In contrast, 0/13 control patients had IgE to 
      the exotoxins (p = 0.031). Polyp eosinophil, lymphocyte, and mononuclear cell 
      counts were compared in IgE exotoxin-positive and -negative subjects. A trend 
      toward increased eosinophil counts in patients with SE IgE (SE IgE+) was present, 
      but not statistically significant. CONCLUSION: These results indicate that a high 
      percentage of CS/NP patients show a systemic IgE response to S. aureus exotoxins 
      in comparison with controls without CS/NP. Although these results are consistent 
      with the actions of Staphylococcus toxins in other diseases, additional work is 
      necessary to establish a local superantigen response in the nasal mucosa of CS/NP 
      patients.
FAU - Conley, David B
AU  - Conley DB
AD  - Department of Otolaryngology--Head and Neck Surgery, Northwestern University 
      Feinberg School of Medicine, Chicago, Illinois 60611, USA.
FAU - Tripathi, Anju
AU  - Tripathi A
FAU - Ditto, Anne M
AU  - Ditto AM
FAU - Reid, Kathryn
AU  - Reid K
FAU - Grammer, Leslie C
AU  - Grammer LC
FAU - Kern, Robert C
AU  - Kern RC
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am J Rhinol
JT  - American journal of rhinology
JID - 8807268
RN  - 0 (Exotoxins)
RN  - 37341-29-0 (Immunoglobulin E)
SB  - IM
MH  - Adult
MH  - Chronic Disease
MH  - Exotoxins/*immunology
MH  - Humans
MH  - Immunoglobulin E/*immunology
MH  - Leukocytes, Mononuclear/immunology
MH  - Lymphocytes/immunology
MH  - Middle Aged
MH  - Nasal Polyps/*immunology
MH  - Sinusitis/*immunology
MH  - Staphylococcus aureus/*immunology
EDAT- 2004/12/14 09:00
MHDA- 2005/02/18 09:00
CRDT- 2004/12/14 09:00
PHST- 2004/12/14 09:00 [pubmed]
PHST- 2005/02/18 09:00 [medline]
PHST- 2004/12/14 09:00 [entrez]
PST - ppublish
SO  - Am J Rhinol. 2004 Sep-Oct;18(5):273-8.