Albumin and immunoglobulin levels in nasal secretions of patients with nasal polyps treated with endoscopic sinus surgery and topical corticosteroids

• Published in: Journal of allergy and clinical immunology 1995-09, Vol.96 (3), p.334-340
• Main Authors: Biewenga, Jeike, Stoop, Anton E., van der Heijden a, Harry A.M.D., van der Baan, Siebren, van Kamp, Gerard J.
• Format: Article
• Language: English
• Subjects: Administration, Topical; Adolescent; Adrenal Cortex Hormones - therapeutic use; Adult; Aged; Biological and medical sciences; budesonide; corticosteroids; Endoscopy; Female; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; immunoglobulin excretion; Immunoglobulins - metabolism; Male; Medical sciences; Middle Aged; Nasal Mucosa - metabolism; Nasal polyps; Nasal Polyps - metabolism; nasal secretion; Paranasal Sinuses - pathology; Paranasal Sinuses - surgery; Recurrence; Reference Values; secretory IgA; Serum Albumin - metabolism; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the upper aerodigestive tract
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/S0091-6749(95)70052-8

Background: Nasal polyposis is principally treated by surgery, which may be combined with administration of topical corticosteroids to postpone or prevent recurrences. Objective: In this study endoscopic sinus surgery and subsequent use of topical corticosteroids (budesonide) for 1 year was evaluated. Methods: Clinical data of 41 patients with nasal polyps were evaluated, and their nasal secretions were compared with those of 26 healthy persons (control subjects). Results: The patients had much higher initial total protein, albumin, IgM, secretory IgA (S-IgA) ( p < 0.001 for all), and IgG concentrations ( p < 0.05) than the control subjects. Treatment resulted in a significant decrease of S-IgA ( p < 0.001) within 6 months. IgM and IgG concentrations decreased more slowly ( p < 0.001 and p < 0.05 at 1 year, respectively). IgE levels decreased, but we could not demonstrate significance. Relative to total protein levels, the albumin and S-IgA levels decreased within 6 months ( p < 0.005 and p < 0.001, respectively). The excretion of all proteins remained higher in patients than in the control subjects, even after 1 year of topical corticosteroid treatment. Clinical evaluation showed slightly higher S-IgA levels in patients with an IgE-mediated allergy than in those without such a condition, and the recurrence rate was highest in the former group (75% vs 48%). Conclusion: The data support the hypothesis that inflammatory reactions in the nasal mucosa play a role in the pathogenesis of nasal polyps but also suggest an additional causative factor. (J A LLERGY C LIN I MMUNOL 1995;96:334-40.)