Measurement of inflammatory mediators of mast cells and eosinophils in native nasal lavage fluid in nasal polyposis.
BACKGROUND
Nasal polyposis (NP) often coexists with asthma, rhinitis and sinusitis. Polyp histology typically shows chronic, eosinophilic inflammation. The inflammatory cell infiltrate generally includes eosinophils, lymphocytes, plasma cells and mast cells.


OBJECTIVE
To gain insight into the natural history of NP, we analysed mediator levels and leukocyte values in nasal fluids and eosinophil cationic protein (ECP), total IgE levels and eosinophils in the blood in several groups of both allergic and non-allergic patients with nasal polyps and in patients with allergic rhinitis (AR).


METHODS
Thirty-two patients with nasal polyps entered the study. As a control group, we studied 55 patients with AR, i.e. 20 patients with seasonal AR to grass pollen, 24 with AR sensitive to Parietaria and 11 with AR sensitive to house dust mite (HDM). Eighteen patients with nasal polyps were also allergic patients (8 were sensitive to Parietaria and 10 were sensitive to HDM), whereas 14 were non-allergic patients. Tryptase and histamine values were assayed in nasal fluids, whereas total IgE was determined in serum. ECP values were assayed both in nasal fluids and serum. Eosinophils were quantified both in the blood and nasal fluids.


RESULTS
Tryptase levels were significantly higher in the nasal lavages from patients with NP than in those from patients without NP (4.7 vs. 3.5 U/l, p < 0.001) and correlated with symptom scores (r(s) = 0.42, p < 0.0001). The median levels of histamine in nasal fluids from patients with NP were also significantly higher than those observed in patients without NP (50.0 vs. 21.3 ng/ml, p < 0.001), but did not correlate with symptom scores. Finally, the median levels of ECP in nasal fluids from patients with NP were significantly higher than those observed in patients without NP (38.1 vs. 16.1 ng/ml, p < 0.001) and correlated with symptom scores (r(s) = 0.38, p < 0.001). Analysis of variance showed that, among the variables studied, the presence of nasal polyps was the factor responsible for the higher levels of tryptase, histamine and ECP in nasal fluids. With regard to leukocyte counts in nasal fluids, no significant differences were observed between rhinitis patients with NP and those without NP. With regard to serum ECP and serum total IgE, no significant differences were detected between the two groups under study. Blood eosinophil levels in patients with NP were significantly higher than those observed in patients without NP (5.8 vs. 5.6, p = 0.002). Analysis of variance showed that both the presence of nasal polyps and the type of sensitisation were important. Considering the total symptom scores, no significant differences were observed between rhinitis patients with NP and those without NP.


CONCLUSIONS
The present findings are consistent with the view that chronic eosinophil mucosal inflammatory disease in NP involves a self-sustaining mechanism, i.e. local release of inflammatory mediators, independent of allergen stimulation of nasal mucosa. Increased release of inflammatory mediators contributes to the development of nasal polyps, determining oedema and an increased recruitment of inflammatory cells. Besides eosinophils, mast cells also play a key role in this process.
Di Lorenzo
G
G
Istituto di Medicina Interna e Geriatria, Dipartimento di Biopatologia e Metodologie Biomediche, Università degli Studi di Palermo, Palermo, Italia. dilo601@pn.itnet.it
Drago
A
A
Esposito Pellitteri
M
M
Candore
G
G
Colombo
A
A
Gervasi
F
F
Pacor
M L
ML
Purello D'Ambrosio
F
F
Caruso
C
C
D000293:Adolescent; D000328:Adult; D000818:Animals; D001798:Blood Proteins / Q000032:analysis; D001826:Body Fluids / Q000737:chemistry* / Q000166:cytology; D047091:Eosinophil Granule Proteins; D004802:Eosinophilia / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D004804:Eosinophils / Q000737:chemistry*; D005260:Female; D006632:Histamine / Q000032:analysis; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D018836:Inflammation Mediators / Q000032:analysis*; D007958:Leukocyte Count; D008297:Male; D008407:Mast Cells / Q000737:chemistry*; D008875:Middle Aged; D008925:Mites / Q000276:immunology; D009296:Nasal Cavity / Q000378:metabolism*; D009298:Nasal Polyps / Q000276:immunology / Q000378:metabolism* / Q000473:pathology; D011058:Pollen / Q000276:immunology; D012221:Rhinitis, Allergic, Perennial / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D006255:Rhinitis, Allergic, Seasonal / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D012260:Ribonucleases; D012697:Serine Endopeptidases / Q000032:analysis; D012720:Severity of Illness Index; D012882:Skin Tests; D007507:Therapeutic Irrigation; D053802:Tryptases
D001798:Blood Proteins; D047091:Eosinophil Granule Proteins; D018836:Inflammation Mediators; D007073:Immunoglobulin E; D006632:Histamine; D012260:Ribonucleases; D012697:Serine Endopeptidases; D053802:Tryptases