Role of specific immunoglobulin-E in chronic rhinosinusitis: Its clinical relevance according to nasal challenge test

Abstract

Background: Guidelines for chronic rhinosinusitis (CRS) propose total IgE and eosinophils as important biomarkers to identify type-2 inflammation. Despite the fact that specific IgE (sIgE) have been identified as a clinical predictor in some type-2 diseases for different clinical outcomes, its role in CRS has yet to be explored in detail.

Objetive: To describe systemic and local sIgE in CRS and explore its possible association with clinical outcomes using nasal challenge tests (NCT).

Methods: In CRS patients, we measure total IgE, serum sIgE (SsIgE) and nasosinusal sIgE (NsIgE) against 9 allergenic sources; Der p, Der f, Blo t, Can f, Fel d, Per a, grasses, Staphylococcus enterotoxin A, and B. NCT was done using the allergen with the higher sIgE prevalence (Der p).

Results: A total of 174 patients were included. Prevalence of SsIgE was 52.8% and NsIgE 46.5%; Der p was the principal allergen for SsIgE and NsIgE. The presence of nasal polyps, asthma comorbidity, NSAID hypersensitivity, and hyposmia, were significantly associated with the presence of SsIgE and NsIgE but not with total IgE. NCT-Der p was performed in 73 CRS patients, being positive in 33 (45.2%). SsIgE have the best diagnostic accuracy (79.4%) to predict NCT results (NsIgE 67.5% total IgE 52%).

Conclusion: Specific IgE is a better biomarker in CRS than total IgE. Patients with clinically relevant SsIgE have a pheno-endotype associated with different clinical outcomes. Considering the clinical relevance of SsIgE demonstrated by NCT, interventions like allergen immunotherapy in CRS must be study.

Keywords: Allergy; Atopy; Dupilumab; Immunoglobulin E; Immunotherapy; Nasal challenge test; Nasal provocation test; Omalizumab; Rhinosinusitis.

Graphical abstract

Fig. 1

sIgE in blood and nasosinusal mucus. Levels of and nasosinusal mucus (NsIgE). In red circles, the patients with serum specific IgE (SsIgE) for each of the allergens. In the purple circle, the nasosinusal mucus specific IgE for each of the allergens

Fig. 2

Diagnostic performance in CRS patients. Diagnostic performance of patients according to positive or negative SsIgE or NsIgE based in NCT results.

Fig. 3

Diagnostic performance in Allergic rhinitis and healthy subjects. Diagnostic performance according to positive or negative SsIgE or NsIgE based in NCT results. (A) allergy rhinitis (AR), (B) healthy subjects.

Fig. 4

NCT and sIgE before and after biologic therapy. Seven patients received biologic therapy (Dupilumab n = 5 and omalizumab n = 2). In green circles patients with dupilumab and in fuchsia patients with omalizumab (n = 2). Change in levels of SsIgE (A) and NsIgE after six months with biological therapy (B). Patients with a second challenge test (C).

Fig. 5

Odd ratio (OR) for SsIgE (Serum specific IgE), NsIgE (Nasal specific IgE), Total IgE, and NCT (Nasal Challenge test). Polyps was defined as polyps in any moment (Actual nasal polyps and previous polyps' surgeries)