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Review
. 2015 Jul;7(4):321-31.
doi: 10.4168/aair.2015.7.4.321. Epub 2015 Mar 5.

Local immunoglobulin e in the nasal mucosa: clinical implications

Els De Schryver  1 , Lien Devuyst  1 , Lara Derycke  1 , Melissa Dullaers  2 , Thibaut Van Zele  1 , Claus Bachert  3 , Philippe Gevaert  4
Affiliations
Review

Local immunoglobulin e in the nasal mucosa: clinical implications

Els De Schryver et al. Allergy Asthma Immunol Res. 2015 Jul.

Abstract

Immunoglobulin E (IgE) can be highly elevated in the airway mucosa independently of IgE serum levels and atopic status. Mostly, systemic markers are assessed to investigate inflammation in airway disease for research or clinical practice. A more accurate but more cumbersome approach to determine inflammation at the target organ would be to evaluate markers locally. We review evidence for local production of IgE in allergic rhinitis (AR) and chronic rhinosinusitis with nasal polyps (CRSwNP). Diagnostic and therapeutic consequences in clinical practice are discussed. We describe that the airway mucosa has the intrinsic capability to produce IgE. Moreover, not only do IgE-positive B cells reside within the mucosa, but all tools are present locally for affinity maturation by somatic hypermutation (SHM), clonal expansion, and class switch recombination to IgE. Recognizing local IgE in the absence of systemic IgE has diagnostic and therapeutic consequences. Therefore, we emphasize the importance of local IgE in patients with a history of AR or CRSwNP.

Keywords: allergic rhinitis; chronic rhinosinusitis with nasal polyps; diagnostics; local IgE; local allergic rhinitis; treatment.

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Conflict of interest statement

There are no financial or other issues that might lead to conflict of interest.

Figures

Fig. 1
Fig. 1. Pathways resulting in local IgE production in CRSwNP. In the first part, dendritic cells of the skin and mucosa process aeroallergens deposited on the mucosa, and subsequently they present antigens to T cells. T helper 2 cells release their mediators upon recognition of antigens presented by antigen-presenting cells. The Th2 cytokines IL4, IL13, and CD40L induce selective somatic recombination of immunoglobulin heavy chain regions in B cells before maturation into IgE-producing plasma cells. IL5 stimulates eosinophil growth and differentiation. Alternatively, IgE is produced by stimulating innate lymphoid cells to release IL4, IL5, and IL13.
Fig. 2
Fig. 2. Local IgE levels in nasal tissue homogenates. In the population with CRSwNP and comorbid asthma, local IgE is highly elevated, as compared to controls, CRSsNP, and CRSwNP without asthma.
Co, controls; CS, CRSsNP; NP, CRSwNP; NP+Asth, CRSwNP and asthma.
See this image and copyright information in PMC

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