Epigenetics Chapter: The Role of Allergy in Chronic Rhinosinusitis
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.
KeywordsAllergic Rhinitis Allergy Clin Immunol Nasal Polyp Chronic Rhinosinusitis Endoscopic Sinus Surgery
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