Epigenetics Chapter: The Role of Allergy in Chronic Rhinosinusitis

  • Daniel L. Hamilos
Part of the Allergy Frontiers book series (ALLERGY, volume 3)


The central question “What is the role of allergy in chronic rhinosinusitis (CRS)?” has several facets. Rather than being amenable to a single answer, the research in this field has asked a series of questions addressing components of the relationship. First, “Does underlying allergic disease contribute to the development of CRS?” Although there are no prospective studies examining this relationship, this question has been addressed in terms of studies showing a relationship between allergic rhinitis and sinus mucosal abnormalities and studies of the incidence of acute bacterial rhinosinmusitis in allergic rhinitis versus nonallergic controls. Second, “Is CRS more severe in patients with underlying allergies?” This question has been addressed in cross-sectional studies examining the extent of sinus mucosal disease in allergic versus nonallergic CRS patients. Third, “Is systemic IgE-mediated allergy a feature of CRS pathology?” This question has been addressed in studies examining differences in CRS tissue pathology in allergic versus nonallergic CRS patients. Fourth, “Is there a special role for local IgE medicated allergy in CRS pathogenesis?” This question has been addressed in studies that have searched for local IgE production to staphylococcal exotoxins and fungal allergens. Fifth, “Is there a different role for allergy in CRS/NP compared to CRS?” This question has been addressed in cross-sectional studies of systemic IgE-mediated allergy in these two conditions as well as studies showing a differential role for local IgE-mediated allergy in CRS/NP patients. Sixth, “Does allergic status impact results of sinus surgery?” This question has been addressed in prospective studies of the outcomes of endoscopic sinus surgery. Finally, “Is there a special role for non-IgE fungal allergen-driven eosinophil accumulation in CRS?” This question has been examined in studies of systemic immune hyperresponsiveness to particular fungal allergens, particularly Alt a1 and direct histopathologic studies of CRS mucus samples.


Allergic Rhinitis Allergy Clin Immunol Nasal Polyp Chronic Rhinosinusitis Endoscopic Sinus Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Emanuel IA, Shah SB. Chronic rhinosinusitis: Allergy and sinus computed tomography relationships. Otolaryngol Head Neck Surg. 2000 Dec;123(6):687–91.PubMedCrossRefGoogle Scholar
  2. 2.
    Asero R, Bottazzi G. Nasal polyposis: A study of its association with airborne allergen hypersensitivity. Ann Allergy Asthma Immunol. 2001 Mar;86(3):283–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Hamilos DL. Chronic rhinosinusitis patterns of illness. Clin Allergy Immunol. 2007;20:1–13.PubMedGoogle Scholar
  4. 4.
    Asero R, Bottazzi G. Hypersensitivity to molds in patients with nasal polyposis: A clinical study. J Allergy Clin Immunol. 2000 Jan;105(1 Pt 1):186–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Berrettini S, Carabelli A, Sellari-Franceschini S, Bruschini L, Abruzzese A, Quartieri F, et al. Perennial allergic rhinitis and chronic sinusitis: Correlation with rhinologic risk factors. Allergy. 1999 Mar;54(3):242–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Blair C, Nelson M, Thompson K, Boonlayangoor S, Haney L, Gabr U, et al. Allergic inflammation enhances bacterial sinusitis in mice. J Allergy Clin Immunol. 2001 Sept;108(3):424–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Yu X, Sperling A, Blair C, Thompson K, Naclerio R. Antigen stimulation of TH2 cells augments acute bacterial sinusitis in mice. J Allergy Clin Immunol. 2004 Aug;114(2):328–34.PubMedCrossRefGoogle Scholar
  8. 8.
    Newman LJ, Platts-Mills TA, Phillips CD, Hazen KC, Gross CW. Chronic sinusitis: Relationship of computed tomographic findings to allergy, asthma, and eosinophilia. JAMA. 1994 Feb 2;271(5):363–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Baroody FM, Suh SH, Naclerio RM. Total IgE serum levels correlate with sinus mucosal thickness on computerized tomography scans. J Allergy Clin Immunol. 1997 Oct;100(4):563–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Ramadan HH, Fornelli R, Ortiz AO, Rodman S. Correlation of allergy and severity of sinus disease. Am J Rhinol. 1999 Sept–Oct;13(5):345–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Lund VJ, Mackay IS. Staging in rhinosinusitus. Rhinology. 1993 Dec;31(4):183–4.PubMedGoogle Scholar
  12. 12.
    Robinson S, Douglas R, Wormald PJ. The relationship between atopy and chronic rhinosinusitis. Am J Rhinol. 2006 Nov–Dec;20(6):625–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Banerji A, Piccirillo JF, Thawley SE, Levitt RG, Schechtman KB, Kramper MA, et al. Chronic rhinosinusitis patients with polyps or polypoid mucosa have a greater burden of illness. Am J Rhinol. 2007 Jan–Feb;21(1):19–26.PubMedCrossRefGoogle Scholar
  14. 14.
    Suzuki M, Watanabe T, Suko T, Mogi G. Comparison of sinusitis with and without allergic rhinitis: Characteristics of paranasal sinus effusion and mucosa. Am J Otolaryngol. 1999 May–June;20(3):143–50.PubMedCrossRefGoogle Scholar
  15. 15.
    Demoly P, Crampette L, Mondain M, Campbell AM, Lequeux N, Enander I, et al. Assessment of inflammation in noninfectious chronic maxillary sinusitis. J Allergy Clin Immunol. 1994 July;94(1):95–108.PubMedCrossRefGoogle Scholar
  16. 16.
    al Ghamdi K, Ghaffar O, Small P, Frenkiel S, Hamid Q. IL-4 and IL-13 expression in chronic sinusitis: Relationship with cellular infiltrate and effect of topical corticosteroid treatment. J Otolaryngol. 1997 June;26(3):160–6.PubMedGoogle Scholar
  17. 17.
    Hamilos DL, Leung DY, Wood R, Meyers A, Stephens JK, Barkans J, et al. Chronic hyperplastic sinusitis: Association of tissue eosinophilia with mRNA expression of granulocyte-macrophage colony-stimulating factor and interleukin-3. J Allergy Clin Immunol. 1993 July;92(1 Pt 1):39–48.PubMedCrossRefGoogle Scholar
  18. 18.
    Hamilos DL, Leung DY, Wood R, Cunningham L, Bean DK, Yasruel Z, et al. Evidence for distinct cytokine expression in allergic versus nonallergic chronic sinusitis. J Allergy Clin Immunol. 1995 Oct;96(4):537–44.PubMedCrossRefGoogle Scholar
  19. 19.
    Pelikan Z, Pelikan-Filipek M. Role of nasal allergy in chronic maxillary sinusitis – diagnostic value of nasal challenge with allergen. J Allergy Clin Immunol. 1990 Oct;86(4 Pt 1):484–91.PubMedCrossRefGoogle Scholar
  20. 20.
    Van Zele T, Gevaert P, Watelet JB, Claeys G, Holtappels G, Claeys C, et al. Staphylococcus aureus colonization and IgE antibody formation to enterotoxins is increased in nasal polyposis. J Allergy Clin Immunol. 2004 Oct;114(4):981–3.PubMedCrossRefGoogle Scholar
  21. 21.
    Humbert M, Durham SR, Ying S, Kimmitt P, Barkans J, Assoufi B, et al. IL-4 and IL-5 mRNA and protein in bronchial biopsies from patients with atopic and nonatopic asthma: Evidence against “intrinsic” asthma being a distinct immunopathologic entity. Am J Respir Crit Care Med. 1996 Nov;154(5):1497–504.PubMedGoogle Scholar
  22. 22.
    Shin SH, Ponikau JU, Sherris DA, Congdon D, Frigas E, Homburger HA, et al. Chronic rhinosinusitis: An enhanced immune response to ubiquitous airborne fungi. J Allergy Clin Immunol. 2004 Dec;114(6):1369–75.PubMedCrossRefGoogle Scholar
  23. 23.
    Harlin SL, Ansel DG, Lane SR, Myers J, Kephart GM, Gleich GJ. A clinical and pathologic study of chronic sinusitis: The role of the eosinophil. J Allergy Clin Immunol. 1988 May; 81(5 Pt 1):867–75.PubMedCrossRefGoogle Scholar
  24. 24.
    Bhattacharyya N, Vyas DK, Fechner FP, Gliklich RE, Metson R. Tissue eosinophilia in chronic sinusitis: Quantification techniques. Arch Otolaryngol Head Neck Surg. 2001 Sept;127(9):1102–5.PubMedGoogle Scholar
  25. 25.
    Yamashita T, Tsuji H, Maeda N, Tomoda K, Kumazawa T. Etiology of nasal polyps associated with aspirin-sensitive asthma. Rhinology Suppl. 1989;8:15–24.Google Scholar
  26. 26.
    Hamilos DL, Leung DY, Huston DP, Kamil A, Wood R, Hamid Q. GM-CSF, IL-5 and RANTES immunoreactivity and mRNA expression in chronic hyperplastic sinusitis with nasal polyposis (NP). Clin Exp Allergy. 1998 Sept;28(9):1145–52.PubMedCrossRefGoogle Scholar
  27. 27.
    Leung DY. Atopic dermatitis: The skin as a window into the pathogenesis of chronic allergic diseases. J Allergy Clin Immunol. 1995 quiz 319; Sept;96(3):302–18.PubMedCrossRefGoogle Scholar
  28. 28.
    Straumann A, Bauer M, Fischer B, Blaser K, Simon HU. Idiopathic eosinophilic esophagitis is associated with a T(H)2-type allergic inflammatory response. J Allergy Clin Immunol. 2001 Dec;108(6):954–61.PubMedCrossRefGoogle Scholar
  29. 29.
    Kennedy DW. Prognostic factors, outcomes and staging in ethmoid sinus surgery. Laryngoscope. 1992 Dec;102(12 Pt 2 Suppl 57):1–18.PubMedGoogle Scholar
  30. 30.
    Emanuel IA, Shah SB. Chronic rhinosinusitis: Allergy and sinus computed tomography relationships. Otolaryngol Head Neck Surg. 2000 Dec;123(6):687–91.PubMedCrossRefGoogle Scholar
  31. 31.
    Gliklich RE, Metson R. Techniques for outcomes research in chronic sinusitis. Laryngoscope. 1995 Apr;105(4 Pt 1):387–90.PubMedCrossRefGoogle Scholar
  32. 32.
    Ramadan HH, Hinerman RA. Outcome of endoscopic sinus surgery in children with allergic rhinitis. Am J Rhinol. 2006 July–Aug;20(4):438–40.PubMedCrossRefGoogle Scholar
  33. 33.
    Ponikau JU, Sherris DA, Kern EB, Homburger HA, Frigas E, Gaffey TA, et al. The diagnosis and incidence of allergic fungal sinusitis. Mayo Clin Proc. 1999 Sept;74(9):877–84.PubMedCrossRefGoogle Scholar
  34. 34.
    Taylor MJ, Ponikau JU, Sherris DA, Kern EB, Gaffey TA, Kephart G, et al. Detection of fungal organisms in eosinophilic mucin using a fluorescein-labeled chitin-specific binding protein. Otolaryngol Head Neck Surg. 2002 Nov;127(5):377–83.PubMedCrossRefGoogle Scholar
  35. 35.
    Collins M, Nair S, Smith W, Kette F, Gillis D, Wormald PJ. Role of local immunoglobulin E production in the pathophysiology of noninvasive fungal sinusitis. Laryngoscope. 2004 July;114(7):1242–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Pant H, Kette FE, Smith WB, Wormald PJ, Macardle PJ. Fungal-specific humoral response in eosinophilic mucus chronic rhinosinusitis. Laryngoscope. 2005 Apr;115(4): 601–6.PubMedGoogle Scholar
  37. 37.
    Pant H, Kette FE, Smith WB, Macardle PJ, Wormald PJ. Eosinophilic mucus chronic rhinosinusitis: Clinical subgroups or a homogeneous pathogenic entity?. Laryngoscope. 2006 July;116(7):1241–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Durham SR, Ying S, Varney VA, Jacobson MR, Sudderick RM, Mackay IS, et al. Cytokine messenger RNA expression for IL-3, IL-4, IL-5, and granulocyte/macrophage-colonystimulating factor in the nasal mucosa after local allergen provocation: Relationship to tissue eosinophilia. J Immunol. 1992 Apr 15;148(8):2390–4.PubMedGoogle Scholar
  39. 39.
    van de Rijn M, Mehlhop PD, Judkins A, Rothenberg ME, Luster AD, Oettgen HC. A murine model of allergic rhinitis: Studies on the role of IgE in pathogenesis and analysis of the eosinophil influx elicited by allergen and eotaxin. J Allergy Clin Immunol. 1998 July;102(1):65–74.CrossRefGoogle Scholar
  40. 40.
    Hamilos DL, Leung DY, Wood R, Bean DK, Song YL, Schotman E, et al. Eosinophil infiltration in nonallergic chronic hyperplastic sinusitis with nasal polyposis (CHS/NP) is associated with endothelial VCAM-1 upregulation and expression of TNF-alpha. Am J Respir Cell Mol Biol. 1996 Oct;15(4):443–50.PubMedGoogle Scholar
  41. 41.
    Miller CH, Pudiak DR, Hatem F, Looney RJ. Accumulation of interferon gamma-producing TH1 helper T cells in nasal polyps. Otolaryngol Head Neck Surg. 1994 July;111(1):51–8.PubMedGoogle Scholar
  42. 42.
    Sanchez-Segura A, Brieva JA, Rodriguez C. T lymphocytes that infiltrate nasal polyps have a specialized phenotype and produce a mixed TH1/TH2 pattern of cytokines. J Allergy Clin Immunol. 1998 Dec;102(6 Pt 1):953–60.PubMedCrossRefGoogle Scholar
  43. 43.
    Ponikau JU, Sherris DA, Kephart GM, Kern EB, Congdon DJ, Adolphson CR, et al. Striking deposition of toxic eosinophil major basic protein in mucus: Implications for chronic rhinosinusitis. J Allergy Clin Immunol. 2005 Aug;116(2):362–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Butterworth AE, David JR, Franks D, Mahmoud AA, David PH, Sturrock RF, et al. Antibody-dependent eosinophil-mediated damage to 51Cr-labeled schistosomula of schistosoma mansoni: Damage by purified eosinophils. J Exp Med. 1977 Jan 1;145(1):136–50.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  • Daniel L. Hamilos
    • 1
  1. 1.Massachusetts General Hospital and Harvard Medical SchoolBostonUSA

Personalised recommendations