Estimation of data of specific allergic research in chronic polypoid rhinosinusitis

Nasal polyposis is a condition which brings physicians more questions than answers.

The materials in this research were 150 patients with a diagnosis of “chronic polypoid rhinosinusitis” aged 15–80 years who were hospitalized in the ENT department of the 3-rd clinic of Tashkent Medical Academy. All patients with chronic polypoid rhinosinusitis was carried specific allergy tests.

In 92 (33,3 %) patients scratch test positive distance. It shows undeniable participation allergic factor in the development of polypoid rhinosinusitis. In the analysis of blood 92 (33,3 %) patients had eosinophilia.

Based on the research results, it is noted that there is a positive skin test allergic reaction to allergens in patients with eosinophilia involves administering topical corticosteroids for pathogenic treatment and II-III generation antihistamines for symptomatic treatment.

Key words: chronic polypoid rhinosinusitis, inflammation, specific allergic research, IgE.

According to the European Position Paper on Polyposis and Sinusitis (EPOS), rhinosinusitis can be categorized as acute, subacute, recurrent and chronic rhinosinusitis (CRS) [1]. The CRS can be subclassified as CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). CRS with and without nasal polyps differ from each other by several markers related to inflammation and tissue remodeling; the foundation of NPs is a chronic inflammatory and remodeling process of the nasal mucosa [2].

Nasal polyposis is a condition which brings physicians more questions than answers. It seems that these days it should not be an issue due to the fact that nasal polyposis affects people for centuries. Nasal polyposis was mentioned in the Hippocrates’s notes from 4th century B. C. [3].

The mucosa of the nasal polyp is thin. In colloid inside of the polyp, we may observe very few small vessels, seromucous glands and cellular infiltrations. In the majority of nasal polyps, eosinophilic granulocytes (eosinophiles) are present [4, 5, 6].

Eosinophilic polyps constitute 70–90 % of all nasal polyps [5,6]. Less common are neutrophilic polyps with the infiltration of neutrophil granulocytes [4]. Because of the variety of nasal polyps, the choice of proper treatment is very difficult [4].

The allergic theory about nasal polyps has been presented in reports from 2011 [4]. Supporters of allergic theory claim that mucosa derived from the polyps of their patients revealed features of an allergic inflammation. An edema and eosinophil granulocytes dominated in the polypoid mucosa. The theory of allergic origin of nasal polyps has not been finally confirmed. The reason for doubts is connected with the fact that the percentage of patients with allergy and diagnosed nasal polyps was only 5 % [4]. The objective of this study was to evaluate of allergic condition of the body in chronic polypoid rhinosinusitis.

The materials in this research were 150 patients with a diagnosis of «chronic polypoid rhinosinusitis» aged 15–80 years who were hospitalized in the ENT department of the 3-rd clinic of Tashkent Medical Academy. All patients with chronic polypoid rhinosinusitis was carried specific allergy tests.

Specific allergy examination included collection allergic history and posing with the allergen skin test.

Allergy survey was conducted by a special scheme developed by the research laboratory Allergic 2-nd clinic of Tashkent Medical Academy.

For allergen skin test allergens were taken from dandelion, fescue, sunflower, wormwood, ash-tree, bonfire, birch, ambrosia, corn, oak, cocksfoot and histamine. Results allergic response was evaluated by the following criteria: +++ — high, ++ — medium and + — low. Statistical processing was carried out on the program Microsoft Excel 2010.

RESULTS

When Allergic study using pollen allergens responses were observed when using the pollen of dandelion, sunflower, corn, oak and ash. High responses (+++) were identified on a dandelion in 14 patients, on sunflower — at 13. In the study of histamine in 92 patients had an allergic reaction, in 29 of them were found high rates. 58 patients achieved an allergic response.

Table 1

These studies allergic patients with chronic polypoid rhinosinusitis

The table shows the different reactions to different degrees for each allergen. Since 92 patients had a positive reaction by varying degrees to histamine. However, fescue, ambrosia, cocksfoot reaction was not observed. In addition, 58 patients had a negative reaction to the allergen.

In 92 patients scratch test positive distance. It shows undeniable participation allergic factor in the development of polypoid rhinosinusitis. These data were correlated with the results of blood tests. Thus, in the analysis of blood 92 (33.3 %) patients had eosinophilia.

Table 2

Eosinophils in the peripheral blood in patients with chronic polypoid rhinosinusitis

Eosinophils in peripheral blood reflect the continuing role of allergy in chronic polypoid rhinosinusitis. Allergic background found in 61,3 % of patients with chronic polypoid rhinosinusitis.

CONCLUSION

Based on the research results, it is noted that there is a positive skin test allergic reaction to allergens in patients with eosinophilia involves administering topical corticosteroids for the purpose of treatment of pathogenic and antihistamines II-III generation purpose symptomatic treatment.

References:

1. Fokkens W. J., Lund V. J., Mullol J. European position paper on nasal polyps. Rhinology. 2007;45(Suppl 20):1–139. 2.
2. Van Crombruggen K., Zhang N., Gevaert P., Tomassen P., Bachert C. Pathogenesis of chronic rhinosinusitis: Inflammation. Current Perspectives. J Allergy Clin Immunol. 2011;128:728–32.
3. Ślifirski J. A., Parzyński S., Fal A. M. Comparison of cytological evaluation of nasal polyps with postoperative histopathology. Alergol Info. 2008;4:120–6.
4. Perić A., Vojvodić D., Vukomanović-Durdevid B. Influence of allergy on clinical, immunological and histological characteristics of nasal polyposis. B-ENT 2012;8(1):25–32.
5. Wen W., Liu W., Zhang L., Bai J., Fan Y., Xia W., Luo Q., Zheng J., Wang H., Li Z., Xia J., Jiang H., Liu Z., Shi J., Li H., Xu G. Increased neutrophilia in nasal polyps reduces the response to oral corticosteroid therapy. J Allergy Clin Immunol. 2012 Jun; 129(6):1522–8.e5.
6. Jeong W. J., Lee C. H., Cho S. H., Rhee C. S. Eosinophilic allergic polyp: a clinically oriented concept of nasal polyp. Otolaryngol Head Neck Surg. 2011 Feb; 144(2):241–6.