Медицинский совет (Nov 2019)
Features of the course of polypous rhinosinusitis combined with allergic rhinitis
Abstract
Both allergic rhinitis (AR) and polypous rhinosinusitis (PRS) are a serious problem in context of their impact on quality of life, the risk of complications, overlay of bronchial asthma (BA) and medical control of these diseases. In most cases, T2 type eosinophilic inflammation lies beneath their pathogenesis, but the mutual influence of simultaneously existing chronic processes on each other appears under-investigated. Objective of the study: Compare the clinical and immunological characteristics of patients with polypous rhinosinusitis and concomitant allergic rhinitis and without respiratory allergy. All patients with PRS were divided into 2 phenotypic groups: Group 1 – PRS without bronchial asthma and respiratory allergy (54 people), Group 2 - PRS + allergic rhinitis, but without bronchial asthma (46 people). IL-1β-, IL-4-, IL-5-, IL-6-, IL-13-, IFN-γ-, TGF-β1-, TGF-β2-, TGF β-3 cytokines in nasal polyp tissue were determined using the Bio-Plex multiplex analysis system. Results: In patients with PRS combined with AR, the eosinophilic type of inflammation in the polyp tissue was determined in 100% of cases, it was accompanied by an increased level of IL-6, TGF-β1, TGF-β2, TGF-β3 and a reduced level of IL-5, IL-13 compared to PRS without comorbid pathology. Conclusions. Given the same clinical course of polypous rhinosinusitis, the identification of the difference in the cytokine profile in the nasal polyp tissue gives evidence of a different mechanism of the inflammatory response for different phenotypes of PRS. The polypous rhinosinusitis combined with allergic rhinitis is characterized by 100% eosinophilic type of inflammation, high levels of TGF-β family protein cytokines, pro-inflammatory cytokine IL-6 and a lower level of T2-cytokines IL-5 and IL-13 compared with the PRS group without comorbid pathology. The simultaneous treatment of PRS and allergic rhinitis using the joint efforts of otorhinolaryngologists and allergists will allow to achieve medical monitoring of both diseases and prevent their progression and development of complications.
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