title: Evidence and role of autoantibodies in chronic rhinosinusitis with nasal polyps.
abstract: In this study, we review our current knowledge of the autoimmune etiopathogenesis of chronic rhinosinusitis with nasal polyps including bacterial infections, viral infections and immunomediated mechanisms and to discuss pathogenesis with relevance for pharmacotherapy. Relevant publications on the etiopathogenesis and treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) from 1977 to 2013 were analyzed. The characteristic signs and symptoms include appearance of relapsing nasal polyps, with typical symptoms such as nasal obstruction, nasal discharge and, usually, loss of the sense of smell. The etiology and pathogenesis remain unknown. Proposed theories of causation include bacterial or viral infections and immunomediated mechanisms. The autoimmune aetiology of unknown origin or failure to respond to classic pharmacological treatments with nasal and oral steroids is now suspected. At present, the nature of the antigen trigger, the exact role played by B/T cells and anti-dsDNA autoantibodies in the pathogenesis of nasal polyposis remains unclear. Corticosteroids and surgery are the first line of treatment in CRSwNP. In the case of corticosteroid treatment failure, other drugs can be used such as rituximab, belimumab or omalizumab which have demonstrated clinical efficacy in the treatment of nasal polyposis with comorbid asthma. Immunosuppressive drugs such as methotrexate, and cyclophosphamide have also been used with varying degrees of success.
authors.affiliation: Department of Sense Organs, ENT Section, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: G F
authors.initials: GF
authors.lastname: Macri
authors.affiliation: Department of Sense Organs, ENT Section, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Greco
authors.affiliation: Department of Sense Organs, ENT Section, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Marinelli
authors.affiliation: Department of Sense Organs, ENT Section, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gallo
authors.affiliation: Department of Sense Organs, ENT Section, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Fusconi
authors.affiliation: Department of Sense Organs, ENT Section, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: De Virgilio
authors.affiliation: Department of Sense Organs, ENT Section, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: De Vincentiis
mesh_terms: D000818:Animals; D000974:Antibodies, Antinuclear / Q000378:metabolism*; D015551:Autoimmunity / Q000187:drug effects; D001402:B-Lymphocytes / Q000276:immunology; D002908:Chronic Disease; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D015508:Nasal Obstruction / Q000276:immunology; D009298:Nasal Polyps / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology / Q000821:virology; D012008:Recurrence; D012220:Rhinitis / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology / Q000821:virology; D012307:Risk Factors; D012852:Sinusitis / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology / Q000821:virology; D013601:T-Lymphocytes / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D000974:Antibodies, Antinuclear; D007155:Immunologic Factors