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Chronic rhinosinusitis: an enhanced immune response to ubiquitous airborne fungi

Seung-Heon Shin1, Jens U Ponikau, David A Sherris

  • 1Department of Internal Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA.

The Journal of Allergy and Clinical Immunology
|December 4, 2004
PubMed
Abstract

Insights

Patients with chronic rhinosinusitis (CRS) exhibit heightened immune responses to airborne fungi like Alternaria. This study reveals abnormal cellular and humoral immunity, suggesting a link between fungal exposure and chronic airway inflammation in CRS.

Area of Science:

  • Immunology
  • Allergy and Immunology
  • Respiratory Medicine

Background:

  • Chronic rhinosinusitis (CRS) is a prevalent chronic illness in the U.S. with unknown causes.
  • Current treatments for CRS lack definitive efficacy.
  • The role of immune system dysfunction in CRS pathogenesis is under investigation.

Purpose of the Study:

  • To test the hypothesis that aberrant immune responses to common airborne fungi contribute to CRS.
  • To investigate the immunologic mechanisms underlying chronic rhinosinusitis.

Main Methods:

  • Peripheral blood mononuclear cells (PBMCs) from CRS patients and healthy individuals were cultured in vitro with fungal extracts (Alternaria, Aspergillus, Cladosporium, Penicillium).
  • Proliferative and cytokine responses (IL-5, IL-13, IFN-gamma) of PBMCs were measured.
  • Serum samples were analyzed for specific IgE and IgG antibodies against the tested fungi.

Main Results:

  • Approximately 90% of CRS patients' PBMCs produced IL-5 and IL-13 in response to Alternaria, unlike healthy individuals.
  • CRS patients showed significantly higher IFN-gamma production when exposed to Alternaria compared to controls.
  • Elevated serum IgG levels to Alternaria and Cladosporium were observed in CRS patients; specific IgE levels were less common.
  • A strong correlation was found between increased serum IgG and increased cellular IL-5 production in response to Alternaria.

Conclusions:

  • Individuals with CRS display exaggerated T(H)1 and T(H)2 type immune responses to common airborne fungi, notably Alternaria.
  • These anomalous immune reactions to ubiquitous fungi may be responsible for the persistent airway inflammation characteristic of CRS.
  • The findings suggest that fungal sensitization plays a critical role in the chronicity of CRS.

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