Skip to main content

Advertisement

SpringerLink
Log in

The Role of IgE Production in the Pathophysiology of Rhinitis and Rhinosinusitis

  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

A multitude of potential etiologies exist for rhinitis and rhinosinusitis. These sinonasal disorders are heterogeneous entities that are best understood by evaluating the causative factors in each individual patient. More precise diagnosis permits accurate and effective treatment. The association of allergy with sinonasal symptoms has been described for decades; however, the specific relationship between allergy, rhinitis, and rhinosinusitis is complex. Considering allergy in terms of a systemic atopic disorder, along with a local inflammatory process mediated by IgE production in sinonasal tissues, is helpful in unveiling the complex connection between allergy, rhinitis, and rhinosinusitis. This article reviews recent literature regarding local IgE and sinonasal inflammatory conditions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Joe SA, Patel S. Nonallergic rhinitis. In: Cummings CW, editor. Otolaryngology: head and neck surgery, chapter 46. 5th ed. Philadelphia: Elsevier Mosby; 2010.

    Google Scholar 

  2. Rondon C, Romero JJ, Lopez S, et al. Local IgE production and positive nasal provocation test in patients with persistent nonallergic rhinitis. J Allergy Clin Immunol. 2007;119:899.

    Article  PubMed  CAS  Google Scholar 

  3. Wedbock A, Enbom H, Eriksson NE, et al. Seasonal non-allergic rhinitis (SNAR)—a new disease entity? A clinical and immunological comparison between SNAR, seasonal allergic rhinitis and persistent non-allergic rhinitis. Rhinology. 2005;43:86.

    Google Scholar 

  4. Powe DG, Jones NS. Local mucosal immunoglobulin E production: does allergy exist in non-allergic rhinitis? Clin Exp Allergy. 2006;36:1367.

    Article  PubMed  CAS  Google Scholar 

  5. Benninger MS. The pathogenesis of rhinosinusitis. In: Cummings CW, editor. Otolaryngology: head and neck surgery, chapter 47. 5th ed. Philadelphia: Elsevier Mosby; 2010.

    Google Scholar 

  6. Benninger MS, Ferguson BJ, Hadley JA, et al. Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg. 2003;129:S1–32.

    Article  PubMed  Google Scholar 

  7. Sanclement JA, Webster P, Thomas J, et al. Bacterial biofilms in surgical specimens of patients with chronic rhinosinusitis. Laryngoscope. 2005;115:578–82.

    Article  PubMed  Google Scholar 

  8. Ramadan HH, Sanclement J, Thomas J. Chronic rhinosinusitis and biofilms. Otolaryngol Head Neck Surg. 2005;132:414–7.

    Article  PubMed  Google Scholar 

  9. Bent J, Kuhn F. Diagnosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg. 1994;111:580–8.

    Article  PubMed  Google Scholar 

  10. Pant H, Kette FE, Smith WB, et al. Fungal-specific humoral response in eosinophilic mucus chronic rhinosinusitis. Laryngoscope. 2005;115:601–6.

    Article  PubMed  CAS  Google Scholar 

  11. DelGaudio JM. Direct nasopharyngeal reflux of gastric acid is a contributing factor in refractory chronic rhinosinusitis. Laryngoscope. 2005;115(6):946–57.

    Article  PubMed  Google Scholar 

  12. Emanuel IA et al. Undertreatment of allergy: exploring the utility of sublingual immunotherapy. Otolaryngol Head Neck Surg. 2009;140:615–21.

    Article  PubMed  Google Scholar 

  13. Scadding GK et al. Basic guidelines for the management of allergic and non-allergic rhinitis. Clin Exp Allergy. 2008;38:19–42.

    Article  PubMed  CAS  Google Scholar 

  14. Van Dishoeck HAE, Franssen MGC. The incidence and correlation of allergy and chronic sinusitis. Pract Otolaryngol. 1957;19:502–6.

    Google Scholar 

  15. Schlerter WW, Man WJ. Sinusitis and allergy. In: Cauwenberg P, Ekedahl C, editors. Advances in sinusitis—microbiological aspects and treatment. Belgium: Scientifica Society for Medical Information; 1981.

    Google Scholar 

  16. Savolainen S. Allergy in patients with acute maxillary sinusitis. Allergy. 1989;44:1116–22.

    Article  Google Scholar 

  17. Karlsson G, Holmberg K. Does allergic rhinitis predispose to sinusitis? Acta Otolaryngol. 1994;515(Suppl):26–8.

    Article  CAS  Google Scholar 

  18. McNally PA, White MV, Kaliner MA. Sinusitis in an allergist’s office: analysis of 200 consecutive cases. Allergy Asthma Proc. 1997;18:169–76.

    Article  PubMed  CAS  Google Scholar 

  19. Emanuel IA, Shah SB. Chronic rhinosinusitis: allergy and sinus computed tomography relationships. Otolaryngol Head Neck Surg. 2000;123:687–91.

    Article  PubMed  CAS  Google Scholar 

  20. Newman LJ, Platts-Mills TA, Phillips CD, et al. Chronic sinusitis. Relationship of computed tomographic findings to allergy, asthma, and eosinophilia. JAMA. 1994;271:363–7.

    Article  PubMed  CAS  Google Scholar 

  21. Rosenfeld RM. Clinical practice guideline: acute sinusitis. Otolaryngol Head Neck Surg. 2007;137(3S):S1–31.

    Article  PubMed  Google Scholar 

  22. Alho OP, Karttunen TJ, Karttunen R, et al. Subjects with allergic rhinitis show signs of more severely impaired paranasal sinus functioning during viral colds than nonallergic subjects. Allergy. 2003;58:767–71.

    Article  PubMed  Google Scholar 

  23. Baroody FM, Mucha SM, de Tineo M, Naclerio RM. Nasal challenge with allergen leads to maxillary sinus inflammation. J Allergy Clin Immunol. 2008;121:1126–32.

    Article  PubMed  CAS  Google Scholar 

  24. Krause HF. Allergy and chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2003;128(1):14–6.

    Article  PubMed  Google Scholar 

  25. Fokkens W, Lund V, Mullol J. European position paper on rhinosinusitis and nasal polyps group. Rhinol Suppl. 2007;20:1–136.

    PubMed  Google Scholar 

  26. Collins MM, Loughran S, Davidson P, Wilson JA. Nasal polyposis: prevalence of positive food and inhalant skin tests. Otolaryngol Head Neck Surg. 2006;135:680–3.

    Article  PubMed  Google Scholar 

  27. Pant H, Ferguson BJ, Macardle PJ. The role of allergy in rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg. 2009;17(3):232–8.

    Article  PubMed  Google Scholar 

  28. Foley S, Hamid Q. Immunopathology of allergic airway inflammation. In: Adkinson NF, editor. Middleton’s allergy: principles and practice, chapter 30. 7th ed. New York: Mosby; 2009.

    Google Scholar 

  29. Hoddeson EK, Pratt EP, Harvey RJ, Wise SK. Local and systemic IgE in the evaluation and treatment of allergy. Otolaryngol Clin North Am. 2010;43(3):503–20.

    Article  PubMed  Google Scholar 

  30. Smurthwaite L, Durham SR. Local IgE synthesis in allergic rhinitis and asthma. Curr Allergy Asthma Rep. 2002;2:231–8.

    Article  PubMed  Google Scholar 

  31. Merret TG, Houri M, Mayer AL, et al. Measurement of specific IgE antibodies in nasal secretion—evidence for local production. Clin Allergy. 1976;6:69–73.

    Article  Google Scholar 

  32. • Wise S, Ahn C, Lathers D, et al. Antigen-specific IgE in sinus mucosa of allergic fungal rhinosinusitis patients. Am J Rhinol. 2008;22:451–6. In this study, sinus tissue specimens from AFS patients demonstrated significantly more IgE-positive cells versus CRSsNP and control sinus tissue specimens. Specific IgE was identified for fungal and nonfungal antigens.

    Article  PubMed  Google Scholar 

  33. Wise SK, Ahn CN, Schlosser RJ. Localized immunoglobulin E expression in allergic rhinitis and nasal polyposis. Curr Opin Otolaryngol Head Neck Surg. 2009;17:216–22.

    Article  PubMed  Google Scholar 

  34. Durham S, Gould H, Thiens C. Expression of the 3 germ-line gene transcripts and mRNA for 3 heavy chain of IgE in nasal B cells and the effects of topical corticosteroid. Eur J Immunol. 1997;27:2899–906.

    Article  PubMed  CAS  Google Scholar 

  35. Takhar P, Smurthwaite L, Coker H. Allergen drives class switching to IgE in the nasal mucosa of allergic rhinitis. J Immunol. 2005;174:5024–32.

    PubMed  CAS  Google Scholar 

  36. • Ahn CN, Wise SK, Lathers DM, et al. Local production of antigen-specific IgE in different anatomic subsites of allergic fungal rhinosinusitis patients. Otolaryngol Head Neck Surg. 2009;141(1):97–103. AFS sinonasal tissue had significantly increased levels of IgE-positive cells compared with specimens from controls and CRSsNP patients. No difference was found in the level of local IgE when comparing different anatomic sites in sinonasal tissue specimens from patients with AFS.

    Article  PubMed  Google Scholar 

  37. • Sheahan P, Ahn CN, Harvey RJ, et al. Local IgE production in non-atopic nasal polyposis. J Otolaryngol Head Neck Surg. 2010;39(1):45–51. Although decreased when compared with atopic patients, nonatopic patients with CRSwNP still demonstrated specific local IgE expression in sinonasal tissue.

    PubMed  Google Scholar 

  38. • Nikakhlagh S, Ghafourian-Boroujerdnia M, Saki N, et al. Immunologic factors in patients with chronic polypoid sinusitis. Niger J Med: J Natl Assoc Resid Doctors Niger. 2010;19(3):316–9. Although serum IgE levels did not differ in CRSwNP patients and healthy controls, IgE in nasal washings was significantly higher in CRSwNP patients, and systemic lymphocyte and CD8 levels were also increased.

    CAS  Google Scholar 

  39. Van Zele T, Gevaert P, Watelet JB, et al. Staphylococcus aureus colonization and IgE antibody formation to enterotoxins is increased in nasal polyposis. J Allergy Clin Immunol. 2004;114:981–3.

    Article  PubMed  Google Scholar 

  40. • Bachert C, Zhang N, Patou J. Role of staphylococcal superantigens in upper airway disease. Curr Opin Allergy Clin Immunol. 2008;8(1):34–8. This was a review paper regarding the role of enterotoxins from S. aureus in the pathophysiology of nasal polyps.

    Article  PubMed  CAS  Google Scholar 

  41. • Bernstein JM, Allen C, Rich G, et al. Further observations on the role of Staphylococcus aureus exotoxins and IgE in the pathogenesis of nasal polyposis. Laryngoscope 2010 (online, ahead of print). Patients with CRSwNP have increased levels of staphylococcal superantigen–specific IgE in nasal mucosa and systemically compared with healthy controls. The authors hypothesize that this may demonstrate a pathophysiologic mechanism for development of polyps.

  42. • Patadia M, Dixon J, Conley D, et al. Evaluation of the presence of B-cell attractant chemokines in chronic rhinosinusitis. Am J Rhinol Allergy. 2010;24(1):11–6. B-cell–attracting chemokines are present in increased amounts in the polyp tissue of patients with CRSwNP as opposed to the turbinate tissue of patients with CRSsNP and healthy controls.

    Article  PubMed  Google Scholar 

  43. • Faith A, Singh N, Chevretton E. Counter regulation of the high affinity IgE receptor, FcεRI, on human airway dendritic cells by IL-4 and IL-10. Allergy. 2009;64(11):1602–7. High-affinity IgE receptor has increased expression on the airway dendritic cells of atopic patients compared with nonatopic patients. Cross-linking of the receptor and IgE induces proinflammatory cytokines in atopic patients and anti-inflammatory cytokines in nonatopic patients.

    Article  PubMed  CAS  Google Scholar 

  44. • Milovanovic M, Drozdenko G, Weise C, et al. Interleukin-17A promotes IgE production in human B cells. J Invest Dermatol. 2010;130(11):2621–8. This was an in vitro study demonstrating that in the presence of IL-4 and CD40 ligand, IL-17 induces IgE synthesis and the upregulation of IgE-producing cells.

    Article  PubMed  CAS  Google Scholar 

  45. • Ciprandi G, Filaci G, Fenoglio D. Th17 cells and allergic rhinitis: is there clinical relevance? Otolaryngol Head Neck Surg. 2010;143(4):604–5. Increased level of local IL-17 is correlated with clinical allergic disease severity.

    Article  PubMed  Google Scholar 

  46. • Wang H, Mobini R, Fang Y, et al. Allergen challenge of peripheral blood mononuclear cells from patients with seasonal allergic rhinitis increases IL-17RB, which regulates basophil apoptosis and degranulation. Clin Exp Allergy. 2010;40(8):1194–202. After allergen exposure in vitro, IL-17RB gene expression is increased to the greatest extent of all genes, and IL-17 promotes IgE-regulated degranulation of basophils.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

Dr. Wise has served on a board, received grant support, and had expenses reimbursed for travel to meetings by the American Academy of Otolaryngic Allergy. Dr. Hoddeson reported no potential conflicts of interest relevant to this article.

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Emory University, 1365A Clifton Road, NE, Atlanta, GA, 30322, USA

    Elizabeth K. Hoddeson & Sarah K. Wise

Authors
  1. Elizabeth K. Hoddeson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah K. Wise
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah K. Wise.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hoddeson, E.K., Wise, S.K. The Role of IgE Production in the Pathophysiology of Rhinitis and Rhinosinusitis. Curr Allergy Asthma Rep 11, 230–235 (2011). https://doi.org/10.1007/s11882-011-0181-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11882-011-0181-z

Keywords

Search

Navigation