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Staphylococcus aureus and pseudomonas aeruginosa are principal pathogens of acute exacerbations following endoscopic sinus surgery
228
Hyper-Immunoglobulinemia E, G, and A in Nasal Polyp Tissue
T. P. J. Van Zele, P. Gevaert, G. Holtappels, P. Van Cauwenberge, C. Bachert; Ear- Nose- and throat dept, University of Ghent, Gent, BELGIUM. RATIONALE: Chronic rhinosinusitis with nasal polyps is a persistent inflammation characterized by a local hyper-immunoglobulinemia E and the presence of specific IgE to Staphylococcus aureus enterotoxins (SAE). We aimed to study the systemic and local production of other immunoglobulines (A, G and M) in relation to plasma cells, B cells and specific IgE to SAE. METHODS: Concentrations of IgE, IgG, IgM, IgA (immunonefelometry) and specific IgE to SAE (Uni-CAP) were determined on tissue homogenates and serum from 18 chronic rhinosinusitis patients with nasal polyps (NP), 13 chronic rhinosinusitis without nasal polyps (CRS) and 13 control patients. Tissue cryo-sections were stained for CD20 and CD138. RESULTS: IgA, IgG and IgE concentrations were significant higher in tissue homogenates of NP compared to CRS and controls. No significant differences were observed in serum levels of IgG, IgA, IgM and IgE between the three groups. NP with specific IgE to SAE had significant higher concentrations of IgG and IgE than those without specific IgE production. Furthermore plasma cell counts (CD138+) were significantly higher in NP tissue compared to controls or CRS. CONCLUSIONS: The difference in IgE, IgG and IgA expression between nasal polyp tissue and serum together with increased numbers of plasma cells suggest a local production of these immunoglobulins in NP. The presence of a local immune response to SAE associated with a higher production of IgE and IgG, but not IgM, indicates a chronic microbial trigger.
Staphylococcus Aureus and Pseudomonas Aeruginosa Are Principal Pathogens of Acute Exacerbations Following Endoscopic Sinus Surgery M. Y. Desrosiers1,2, H. Al-Shemari1, W. Abou-Hamad1, A. Hussain1, M. Poisson3, M. Libman4; 1Otolaryngology - Head and Neck Surgery, McGill University Health Centre, Montreal, PQ, CANADA, 2Otolaryngology-Head and Neck Surgery, Centre Hospitalier Universite de Montreal, Montreal, PQ, CANADA, 3Infectious Diseases, Centre Hospitalier Universite de Montreal, Montreal, PQ, CANADA, 4Infectious Diseases, McGill University Health Centre, Montreal, PQ, CANADA. RATIONALE: While S Aureus and P Aeruginosa are frequently recovered in symptomatic patients after ESS, a lack of comparative data makes it difficult to interpret the significance of these findings. We propose to determine whether bacteriology of exacerbations of sinusitis post-ESS differs from the normal flora of the healthy sinus cavity. METHODS: Between October 2002 and March 2003, 41 consecutive patients presenting with exacerbations of chronic sinusitis (symptoms lasting from 7 to 30 days with evidence of purulent secretions and/or inflammation on nasal endoscopy at least 12 weeks post-ESS) underwent endoscopically guided cultures of the involved sinuses. These were compared with a group of 21 asymptomatic patients having previously undergone ESS, using the same culture methods. RESULTS: 40 patients with acute exacerbations (98%) were infected with at least one species (mean 1.5/ pt). Organisms recovered were S Aureus (54%), coagulase - negative staphylococci (29%) (CNS), gramnegative rods (5%)(GNR), and Pseudomonas Aeruginosa (22%). While 10 patients grew either Streptococcus Pneumoniae or Haemophilus Influenzae (25%), only 2 patients (5%) grew them as sole agents. In 21 asymptomatic subjects, bacterial recovery rate was 100% (mean 1.7 species/pt). Organisms recovered were CNS 76%, diptheroids, 29%, S Aureus 24%, P Aeruginosa 5%. 1 patient (5%) grew S Pneumoniae in a mixed culture. CONCLUSIONS: Staphylococcus Aureus and Pseudomonas Aeruginosa are recovered mainly from symptomatic patients after ESS. This differs markedly from the flora of the healthy sinus cavity and suggests they may contribute to the disease process. Therapy may have to be directed towards these organisms in the future
229
Nasal Eosinophils Display the Best Correlation With Symptoms, Pulmonary Function, and Inflammation in Allergic Rhinitis G. Ciprandi1, A. Vizzaccaro2, I. Cirillo2, M. Tosca3, A. Massolo4, G. Passalcqua5, G. Passalacqua5; 1Head-Neck Dept, S.Martino Hospital, Genoa, ITALY, 2Navy Military Hospital, La Spezia, ITALY, 3Giannina Gaslini Institute, Genoa, ITALY, 4Dept of Environmental Sciences, University of Siena, Siena, ITALY, 5Dept Allergy & Respiratory Diseases, S.Martino Hospital, Genoa, ITALY. BACKGROUND: The pathogenesis of allergic rhinitis and its link with asthma are well known. Nevertheless, a complete cross-sectional evaluation of the usually available clinical, functional and immunological parameters has never been made. We assessed nasal symptoms and flow, cytology, cytokines, pulmonary function and methacholine positivity in a large number of patients with pure pollinosis. METHODS: Young men were selected among those seen at a military hospital for routine visits. They had to suffer from rhinitis alone (without asthma) since at least two years and to had skin positivity to pollens only. During the pollen season they underwent: symptom evaluation, measurement of nasal flow, nasal scraping and lavage (cell count and assay for IL4, IL-5, IL-8 and IFNg), pulmonary function test and methacholine challenge. RESULTS: Fifty subjects (23.7 ± 4.9 years) were enrolled. All patients had high clinical scores (9.5±1.6) and inflammatory cells (eos 10.5±4, neu 21.3±6) and low nasal flow (482±111 mL/s). We found that the number of eosinophils in nasal scraping highly correlated with all the mentioned parameters, including nasal flow, cytokines and spirometric values. A significant positive correlation was found between all inflammatory cells and all cytokines. IL-8, IL-4 and neutrophils displayed only a partial correlation with pulmonary parameters (FEV1, FVC and FEF25-75%), at variance wit IL-5 and eosinophils. Methacholine test positivity significantly correlated with the number of eosinophils in the nasal smear. CONCLUSION: Eosinophils in nasal smear display the best correlation with all the clinical and immunological parameters in allergic rhinitis and also well correlate with methacholine sensitivity. Funding: Genoa University
230
Risk Factors for Adenoidal Regrowth Post-Adenoidectomy: Comparison Between Allergic and Non-Allergic Etiologies S. Kung, S. J. McGeady, E. Yousef; Allergy, Asthma and Immunology, Thomas Jefferson University, AI duPont Hospital for Children, Wilmington, DE. RATIONALE: Adenoidal hypertrophy causes morbidity in children. Regrowth can occur post-adenoidectomy, however, specific risk factors for regrowth have not been identified. Our objective was to determine what factors might contribute to adenoidal regrowth. METHODS: A review of rhinitis patients with oral breathing from January 2001 - June 2004 was performed. Children with previous adenoidectomy were the study population. Group 1 was patients with adenoidal hypertrophy as documented on lateral neck x-ray following a prior adenoidectomy. This was compared with group 2, who did not have adenoidal regrowth by radiograph. Factors considered were allergen sensitivity, tobacco smoke exposure, sinusitis episodes and presence of gastroesophageal reflux disease (GERD). RESULTS: Of 506 rhinitis patients, 85 (17%) were post-adenoidectomy and demonstrated persistent oral breathing. Lateral neck x-ray was taken in 43/85 (51%), revealing adenoidal regrowth in 20/43 (47%). There was no significant difference in tobacco exposure and prevalence of sinusitis between the 2 groups. However, skin tests to environmental allergens were positive in 10/20(50%) in group 1, and 5/23 (22%) in group 2 (p=0.05). GERD was documented by history and diagnostic studies in 15/20 (75%) in group 1 compared to 9/23 (39%) in group 2 (p=0.02). CONCLUSIONS: Our study revealed that GERD may be an important cause of adenoidal regrowth post-adenoidectomy. Although not as highly significant, sensitivity to aeroallergens may similarly be a risk factor. Early identification and appropriate treatment of GERD and allergen sensitivity may prevent adenoidal hypertrophy.
231
SATURDAY
Abstracts S57
J ALLERGY CLIN IMMUNOL VOLUME 115, NUMBER 2
Hyper-Immunoglobulinemia E, G, and A in Nasal Polyp Tissue
T. P. J. Van Zele, P. Gevaert, G. Holtappels, P. Van Cauwenberge, C. Bachert; Ear- Nose- and throat dept, University of Ghent, Gent, BELGIUM. RATIONALE: Chronic rhinosinusitis with nasal polyps is a persistent inflammation characterized by a local hyper-immunoglobulinemia E and the presence of specific IgE to Staphylococcus aureus enterotoxins (SAE). We aimed to study the systemic and local production of other immunoglobulines (A, G and M) in relation to plasma cells, B cells and specific IgE to SAE. METHODS: Concentrations of IgE, IgG, IgM, IgA (immunonefelometry) and specific IgE to SAE (Uni-CAP) were determined on tissue homogenates and serum from 18 chronic rhinosinusitis patients with nasal polyps (NP), 13 chronic rhinosinusitis without nasal polyps (CRS) and 13 control patients. Tissue cryo-sections were stained for CD20 and CD138. RESULTS: IgA, IgG and IgE concentrations were significant higher in tissue homogenates of NP compared to CRS and controls. No significant differences were observed in serum levels of IgG, IgA, IgM and IgE between the three groups. NP with specific IgE to SAE had significant higher concentrations of IgG and IgE than those without specific IgE production. Furthermore plasma cell counts (CD138+) were significantly higher in NP tissue compared to controls or CRS. CONCLUSIONS: The difference in IgE, IgG and IgA expression between nasal polyp tissue and serum together with increased numbers of plasma cells suggest a local production of these immunoglobulins in NP. The presence of a local immune response to SAE associated with a higher production of IgE and IgG, but not IgM, indicates a chronic microbial trigger.
Staphylococcus Aureus and Pseudomonas Aeruginosa Are Principal Pathogens of Acute Exacerbations Following Endoscopic Sinus Surgery M. Y. Desrosiers1,2, H. Al-Shemari1, W. Abou-Hamad1, A. Hussain1, M. Poisson3, M. Libman4; 1Otolaryngology - Head and Neck Surgery, McGill University Health Centre, Montreal, PQ, CANADA, 2Otolaryngology-Head and Neck Surgery, Centre Hospitalier Universite de Montreal, Montreal, PQ, CANADA, 3Infectious Diseases, Centre Hospitalier Universite de Montreal, Montreal, PQ, CANADA, 4Infectious Diseases, McGill University Health Centre, Montreal, PQ, CANADA. RATIONALE: While S Aureus and P Aeruginosa are frequently recovered in symptomatic patients after ESS, a lack of comparative data makes it difficult to interpret the significance of these findings. We propose to determine whether bacteriology of exacerbations of sinusitis post-ESS differs from the normal flora of the healthy sinus cavity. METHODS: Between October 2002 and March 2003, 41 consecutive patients presenting with exacerbations of chronic sinusitis (symptoms lasting from 7 to 30 days with evidence of purulent secretions and/or inflammation on nasal endoscopy at least 12 weeks post-ESS) underwent endoscopically guided cultures of the involved sinuses. These were compared with a group of 21 asymptomatic patients having previously undergone ESS, using the same culture methods. RESULTS: 40 patients with acute exacerbations (98%) were infected with at least one species (mean 1.5/ pt). Organisms recovered were S Aureus (54%), coagulase - negative staphylococci (29%) (CNS), gramnegative rods (5%)(GNR), and Pseudomonas Aeruginosa (22%). While 10 patients grew either Streptococcus Pneumoniae or Haemophilus Influenzae (25%), only 2 patients (5%) grew them as sole agents. In 21 asymptomatic subjects, bacterial recovery rate was 100% (mean 1.7 species/pt). Organisms recovered were CNS 76%, diptheroids, 29%, S Aureus 24%, P Aeruginosa 5%. 1 patient (5%) grew S Pneumoniae in a mixed culture. CONCLUSIONS: Staphylococcus Aureus and Pseudomonas Aeruginosa are recovered mainly from symptomatic patients after ESS. This differs markedly from the flora of the healthy sinus cavity and suggests they may contribute to the disease process. Therapy may have to be directed towards these organisms in the future
229
Nasal Eosinophils Display the Best Correlation With Symptoms, Pulmonary Function, and Inflammation in Allergic Rhinitis G. Ciprandi1, A. Vizzaccaro2, I. Cirillo2, M. Tosca3, A. Massolo4, G. Passalcqua5, G. Passalacqua5; 1Head-Neck Dept, S.Martino Hospital, Genoa, ITALY, 2Navy Military Hospital, La Spezia, ITALY, 3Giannina Gaslini Institute, Genoa, ITALY, 4Dept of Environmental Sciences, University of Siena, Siena, ITALY, 5Dept Allergy & Respiratory Diseases, S.Martino Hospital, Genoa, ITALY. BACKGROUND: The pathogenesis of allergic rhinitis and its link with asthma are well known. Nevertheless, a complete cross-sectional evaluation of the usually available clinical, functional and immunological parameters has never been made. We assessed nasal symptoms and flow, cytology, cytokines, pulmonary function and methacholine positivity in a large number of patients with pure pollinosis. METHODS: Young men were selected among those seen at a military hospital for routine visits. They had to suffer from rhinitis alone (without asthma) since at least two years and to had skin positivity to pollens only. During the pollen season they underwent: symptom evaluation, measurement of nasal flow, nasal scraping and lavage (cell count and assay for IL4, IL-5, IL-8 and IFNg), pulmonary function test and methacholine challenge. RESULTS: Fifty subjects (23.7 ± 4.9 years) were enrolled. All patients had high clinical scores (9.5±1.6) and inflammatory cells (eos 10.5±4, neu 21.3±6) and low nasal flow (482±111 mL/s). We found that the number of eosinophils in nasal scraping highly correlated with all the mentioned parameters, including nasal flow, cytokines and spirometric values. A significant positive correlation was found between all inflammatory cells and all cytokines. IL-8, IL-4 and neutrophils displayed only a partial correlation with pulmonary parameters (FEV1, FVC and FEF25-75%), at variance wit IL-5 and eosinophils. Methacholine test positivity significantly correlated with the number of eosinophils in the nasal smear. CONCLUSION: Eosinophils in nasal smear display the best correlation with all the clinical and immunological parameters in allergic rhinitis and also well correlate with methacholine sensitivity. Funding: Genoa University
230
Risk Factors for Adenoidal Regrowth Post-Adenoidectomy: Comparison Between Allergic and Non-Allergic Etiologies S. Kung, S. J. McGeady, E. Yousef; Allergy, Asthma and Immunology, Thomas Jefferson University, AI duPont Hospital for Children, Wilmington, DE. RATIONALE: Adenoidal hypertrophy causes morbidity in children. Regrowth can occur post-adenoidectomy, however, specific risk factors for regrowth have not been identified. Our objective was to determine what factors might contribute to adenoidal regrowth. METHODS: A review of rhinitis patients with oral breathing from January 2001 - June 2004 was performed. Children with previous adenoidectomy were the study population. Group 1 was patients with adenoidal hypertrophy as documented on lateral neck x-ray following a prior adenoidectomy. This was compared with group 2, who did not have adenoidal regrowth by radiograph. Factors considered were allergen sensitivity, tobacco smoke exposure, sinusitis episodes and presence of gastroesophageal reflux disease (GERD). RESULTS: Of 506 rhinitis patients, 85 (17%) were post-adenoidectomy and demonstrated persistent oral breathing. Lateral neck x-ray was taken in 43/85 (51%), revealing adenoidal regrowth in 20/43 (47%). There was no significant difference in tobacco exposure and prevalence of sinusitis between the 2 groups. However, skin tests to environmental allergens were positive in 10/20(50%) in group 1, and 5/23 (22%) in group 2 (p=0.05). GERD was documented by history and diagnostic studies in 15/20 (75%) in group 1 compared to 9/23 (39%) in group 2 (p=0.02). CONCLUSIONS: Our study revealed that GERD may be an important cause of adenoidal regrowth post-adenoidectomy. Although not as highly significant, sensitivity to aeroallergens may similarly be a risk factor. Early identification and appropriate treatment of GERD and allergen sensitivity may prevent adenoidal hypertrophy.
231
SATURDAY
Abstracts S57
J ALLERGY CLIN IMMUNOL VOLUME 115, NUMBER 2