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The Prevalence Of AERD In a Tertiary Care Center
Abstracts AB131
J ALLERGY CLIN IMMUNOL VOLUME 133, NUMBER 2
The Prevalence Of AERD In a Tertiary Care Center Dr. Whitney Wyatt Stevens, MD, PhD1, Dr. Anju T. Peters, MD, FAAAAI1, Dr. Kathryn E. Hulse, PhD2, Dr. Leslie C. Grammer, MD, FAAAAI1, Dr. Joy Hsu, MD, MSCI1, Prof. Pedro C. Avila, MD, FAAAAI1, Mr. James Norton, MS1, Ms. Lydia Suh, BSc1, Dr. Rakesh Chandra, MD2, Dr. David Conley, MD3, Dr. Robert C. Kern, MD3, Dr. Bruce K. Tan, MD3, Dr. Robert P. Schleimer, PhD, FAAAAI4; 1Department of Medicine, Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, 2 Northwestern University, Chicago, IL, 3Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, 4Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. RATIONALE: Aspirin exacerbated respiratory disease (AERD) is characterized by asthma, chronic rhinosinusitis with nasal polyps (CRSwNP) and aspirin sensitivity. While patients with AERD tend to have more severe sinus disease when compared to patients with CRSwNP alone, factors and mechanisms that account for such differences are not well understood. In order to study AERD pathogenesis, we first identified and characterized patients with AERD, CRSwNP+Asthma, and CRSwNP alone by evaluation of records from a tertiary care center. METHODS: Electronic health record data from over 1 million entries in the Northwestern Medicine Enterprise Data Warehouse were utilized to identify patients with sinusitis, nasal polyps, and/or history of sinus surgery. From this cohort, we identified 62 patients with AERD defined as having 1) physician-diagnosed asthma; 2) CRSwNP as documented by nasal endoscopy and/or sinus CT; and 3) history of rhinorrhea and/or wheeze following aspirin ingestion. Fifty-four patients with CRSwNP+Asthma and 54 with CRSwNP alone were included who were surgical candidates previously recruited for other CRS studies. RESULTS: Patients with AERD, on average, underwent significantly more sinus surgeries then patients with CRSwNP+Asthma (p<0.01) or CRSwNP alone (p<0.01). There was a higher prevalence of women (61%) and physician-reported atopy (87%) in AERD when compared to CRSwNP alone (30% and 53% respectively). Interestingly, there were no statistically significant differences between AERD and CRSwNP+Asthma in regards to gender, atopy, or asthma severity. CONCLUSIONS: In our population, we found patients with AERD had a similar prevalence of gender, atopy, and asthma as patients with CRSwNP+Asthma yet, on average, underwent more sinus surgeries.
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Expression Of Hypoxia-Inducible Factor 1alpha In Regulatory T Cells Is Associated With Nasal Polypogenesis Prof. Yong Min Kim1, Dr. Jun Jin2, Dr. Dong-Yeop Chang3, Sung Ha Kim4, Ki-Sang Rha4; 1Chungnam National University School of Medicine, Daejeon, South Korea, 2Chungnam National University School of Medicine, 3Laboratory of Immunology and Infectious Diseases, Graduate School of Medical Science and Engineering, KAIST, Daejeon, South Korea, 4Chungnam National University School of Medicine, South Korea. RATIONALE: Hypoxia-inducible factor 1alpha (HIF-1a) is considered as a key molecule in regulating Th17:regulatory T-cells (Tregs) balance. The aims of this study were to investigate whether HIF-1a is associated with the orphan nuclear receptor gamma (RORg) expression of Tregs in nasal polyps and to verify whether SEB is involved in this process. METHODS: Forty patients with Chronic rhinosinusitis with nasal polyposis (CRSwNP) were enrolled and divided into eosinophilic nasal polyps (EPs) and non-eosinophilic nasal polyps (NEPs) according to the proportion of eosinophils. Fifteen subjects who were undergoing septoplasty were enrolled as control subjects. Expressions of HIF-1a in the tissue were measured using RT-PCR, western blot, and flow cytometry. The mRNA expression of RORC and HIF-1a in Tregs separated from tissues were measured by RT-PCR. Double immunofluorescent (IF) staining for RORC/FOXP3 and HIF-1a/FOXP3 were conducted on the tissues.
Expressions of RORC and HIF-1a in Tregs from PBMC were measured using flow cytometry after stimulation with SEB. RESULTS: Expressions RORC and HIF-1a in Tregs were significantly higher in EPs and NEPs compared with control mucosa, and there was a significant correlation between RORC and HIF-1a expression in Tregs. Expressions of RORC and HIF-1a mRNA in Tregs separated from the tissues were also significantly higher in nasal polyps compared with control mucosa. Expression of RORC and HIF-1a in Tregs were increased after 24 hour stimulation with SEB in the PBMCs. CONCLUSIONS: HIF-1a-induced RORC expressions in Tregs may play a key role in the pathogenesis of nasal polyps.
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Prognoistic Factors For Olfaction After Endoscopic Sinus Surgery In Chronic Sinusitis With Or Without Allergy Dr. Byung Guk KIM1, Jihyun SHIN2, Chan Soon PARK2, Dr. Soo Whan Kim3, JUN Myung Kang2, So Young PARK2; 1The Catholic University Of Korea, Seoul, Korea, South Korea, 2The Catholic University Of Korea, Seoul, Korea, 3The Catholic University of Korea. RATIONALE: Chronic rhinosinusitis (CRS) is one of the most common causes of olfactory dysfunction. After endoscopic sinus surgery (ESS), olfactory function would be improved in most cases or not in some cases. Therefore the purpose of this study was to investigate the prognostic factors for olfaction improvement after endoscopic sinus surgery in CRS. METHODS: 107 patients with CRS who underwent ESS were studied. We performed olfactory function test for all patients using the Butanol threshold test (BTT) and Cross Cultural Smell Identification test (CC-SIT) preoperatively and postoperatively. The patients‘ subjective symptoms were also recorded using the Visual Analog Scale (VAS) pre-and postoperatively. We also analyzed the duration of disease and preoperative computed tomography. RESULTS: The improvement of olfactory function after ESS in patients with longer duration of symptoms was significantly lower than in patients with shorter duration. Alllergy, CT scores and involvement of ethmoid sinuses were not influenced the postoperative improvement of olfaction significantly. CONCLUSIONS: The improvement of olfaction after ESS not depends on the presense of allergy but mainly depends on the duration of CRS. Therefore, for the better outcome of ESS especially in olfactory function, early and proper treatment for CRS will be necessary.
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J ALLERGY CLIN IMMUNOL VOLUME 133, NUMBER 2
The Prevalence Of AERD In a Tertiary Care Center Dr. Whitney Wyatt Stevens, MD, PhD1, Dr. Anju T. Peters, MD, FAAAAI1, Dr. Kathryn E. Hulse, PhD2, Dr. Leslie C. Grammer, MD, FAAAAI1, Dr. Joy Hsu, MD, MSCI1, Prof. Pedro C. Avila, MD, FAAAAI1, Mr. James Norton, MS1, Ms. Lydia Suh, BSc1, Dr. Rakesh Chandra, MD2, Dr. David Conley, MD3, Dr. Robert C. Kern, MD3, Dr. Bruce K. Tan, MD3, Dr. Robert P. Schleimer, PhD, FAAAAI4; 1Department of Medicine, Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, 2 Northwestern University, Chicago, IL, 3Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, 4Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. RATIONALE: Aspirin exacerbated respiratory disease (AERD) is characterized by asthma, chronic rhinosinusitis with nasal polyps (CRSwNP) and aspirin sensitivity. While patients with AERD tend to have more severe sinus disease when compared to patients with CRSwNP alone, factors and mechanisms that account for such differences are not well understood. In order to study AERD pathogenesis, we first identified and characterized patients with AERD, CRSwNP+Asthma, and CRSwNP alone by evaluation of records from a tertiary care center. METHODS: Electronic health record data from over 1 million entries in the Northwestern Medicine Enterprise Data Warehouse were utilized to identify patients with sinusitis, nasal polyps, and/or history of sinus surgery. From this cohort, we identified 62 patients with AERD defined as having 1) physician-diagnosed asthma; 2) CRSwNP as documented by nasal endoscopy and/or sinus CT; and 3) history of rhinorrhea and/or wheeze following aspirin ingestion. Fifty-four patients with CRSwNP+Asthma and 54 with CRSwNP alone were included who were surgical candidates previously recruited for other CRS studies. RESULTS: Patients with AERD, on average, underwent significantly more sinus surgeries then patients with CRSwNP+Asthma (p<0.01) or CRSwNP alone (p<0.01). There was a higher prevalence of women (61%) and physician-reported atopy (87%) in AERD when compared to CRSwNP alone (30% and 53% respectively). Interestingly, there were no statistically significant differences between AERD and CRSwNP+Asthma in regards to gender, atopy, or asthma severity. CONCLUSIONS: In our population, we found patients with AERD had a similar prevalence of gender, atopy, and asthma as patients with CRSwNP+Asthma yet, on average, underwent more sinus surgeries.
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Expression Of Hypoxia-Inducible Factor 1alpha In Regulatory T Cells Is Associated With Nasal Polypogenesis Prof. Yong Min Kim1, Dr. Jun Jin2, Dr. Dong-Yeop Chang3, Sung Ha Kim4, Ki-Sang Rha4; 1Chungnam National University School of Medicine, Daejeon, South Korea, 2Chungnam National University School of Medicine, 3Laboratory of Immunology and Infectious Diseases, Graduate School of Medical Science and Engineering, KAIST, Daejeon, South Korea, 4Chungnam National University School of Medicine, South Korea. RATIONALE: Hypoxia-inducible factor 1alpha (HIF-1a) is considered as a key molecule in regulating Th17:regulatory T-cells (Tregs) balance. The aims of this study were to investigate whether HIF-1a is associated with the orphan nuclear receptor gamma (RORg) expression of Tregs in nasal polyps and to verify whether SEB is involved in this process. METHODS: Forty patients with Chronic rhinosinusitis with nasal polyposis (CRSwNP) were enrolled and divided into eosinophilic nasal polyps (EPs) and non-eosinophilic nasal polyps (NEPs) according to the proportion of eosinophils. Fifteen subjects who were undergoing septoplasty were enrolled as control subjects. Expressions of HIF-1a in the tissue were measured using RT-PCR, western blot, and flow cytometry. The mRNA expression of RORC and HIF-1a in Tregs separated from tissues were measured by RT-PCR. Double immunofluorescent (IF) staining for RORC/FOXP3 and HIF-1a/FOXP3 were conducted on the tissues.
Expressions of RORC and HIF-1a in Tregs from PBMC were measured using flow cytometry after stimulation with SEB. RESULTS: Expressions RORC and HIF-1a in Tregs were significantly higher in EPs and NEPs compared with control mucosa, and there was a significant correlation between RORC and HIF-1a expression in Tregs. Expressions of RORC and HIF-1a mRNA in Tregs separated from the tissues were also significantly higher in nasal polyps compared with control mucosa. Expression of RORC and HIF-1a in Tregs were increased after 24 hour stimulation with SEB in the PBMCs. CONCLUSIONS: HIF-1a-induced RORC expressions in Tregs may play a key role in the pathogenesis of nasal polyps.
463
Prognoistic Factors For Olfaction After Endoscopic Sinus Surgery In Chronic Sinusitis With Or Without Allergy Dr. Byung Guk KIM1, Jihyun SHIN2, Chan Soon PARK2, Dr. Soo Whan Kim3, JUN Myung Kang2, So Young PARK2; 1The Catholic University Of Korea, Seoul, Korea, South Korea, 2The Catholic University Of Korea, Seoul, Korea, 3The Catholic University of Korea. RATIONALE: Chronic rhinosinusitis (CRS) is one of the most common causes of olfactory dysfunction. After endoscopic sinus surgery (ESS), olfactory function would be improved in most cases or not in some cases. Therefore the purpose of this study was to investigate the prognostic factors for olfaction improvement after endoscopic sinus surgery in CRS. METHODS: 107 patients with CRS who underwent ESS were studied. We performed olfactory function test for all patients using the Butanol threshold test (BTT) and Cross Cultural Smell Identification test (CC-SIT) preoperatively and postoperatively. The patients‘ subjective symptoms were also recorded using the Visual Analog Scale (VAS) pre-and postoperatively. We also analyzed the duration of disease and preoperative computed tomography. RESULTS: The improvement of olfactory function after ESS in patients with longer duration of symptoms was significantly lower than in patients with shorter duration. Alllergy, CT scores and involvement of ethmoid sinuses were not influenced the postoperative improvement of olfaction significantly. CONCLUSIONS: The improvement of olfaction after ESS not depends on the presense of allergy but mainly depends on the duration of CRS. Therefore, for the better outcome of ESS especially in olfactory function, early and proper treatment for CRS will be necessary.
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