Clinical symptoms, free histamine and IgE in patients with nasal polyposis

29 adult patients with nasal polyps were studied. The clinical symptoms and atopic profile were compared with both the level of histamine and IgE found in polyp fluid. The high concentration of free histamine found in polyp fluid was probably pathological, and local IgE was present in greater amounts than expected by simple diffusion. There was no evidence that clinical hypersensitivity is associated with higher concentrations of IgE and histamine in polyp fluid; it is possible that mechanisms other than an IgE-mediated response could cause degranulation of mast cells in nasal polyps.

Multifactorial etiology of nasal polyps

Forty patients with nasal polyps were assessed. Elevated serum total IgE levels in nine patients did not correlate with skin testing. Increased serum immune complexes were detected in 11 patients but did not correlate with depressed complement (five patients). Multiple immunological mechanisms may be involved in nasal polyp formation.

HLA antigens, nasal polyps and asthma

HLA typing has been performed on a selected series of 29 patients with nasal polyps, with or without asthma. Despite the small series there was a significant incease in the haplotype AI/B8 in patients with both nasal polyps and asthma. No association was found in those with polyps alone. However, those with both conditions, who were positive for AI/B8, had more severe polyp disease. Three out of 4 patients with nasal polyps, asthma and sensitivity to aspirin were positive for AI/B8. In patients with nasal polyps, tissue typing sensitivity to aspirin were positive for AI/B8. In patients with nasal polyps, tissue typing might be of use in predicting both those who are most at risk of developing asthma, and also those who are most likely to have severe polyp disease. The association of AI/B8 with severe polyp disease and asthma, may imply that abnormalities of immune response are likely to be associated with the pathogenesis of both conditions.

[Antibodies to staphylococcal autostrains in polypoid tissue of the human nasal mucosa]

The immune response of the body to different clones of nasal staphylococcal population in polypous rhinosinusitis has been studied. The titers of antibodies to different staphylococcal clones were shown to differ considerably. The titers of antibodies to different clones in polypous tissue were found to be higher or lower than the respective titers in the general blood stream. Thus different immunologic conditions for the development of microorganisms could locally appear in the presence of intensive general immune reaction. This seems to be due to differences in the intensity of the production of antibodies to these microorganisms in the lymphoid tissue of the nasal mucosa.

Local immune system of nasal nucosa in inflammation. IgA distribution and secretory activity

The local immune system of human mucosa (inferior turbinates and nasal polyps) from 53 humans with chronic inflammation was studied by examining the distribution and secretory activity of IgA using an immunofluorescent technique. Diffuse fluorescence for IgA was observed throughout the connective tissue ground substance in every nasal turbinate and nasal polyp. In mucosa with mild inflammatory changes, most IgA seemed to be produced locally by IgA-producing plasma cells. However, in severely inflamed nasal mucosa, including nasal polyps, plasma cells were relatively fewer in number and the distribution of IgA generally corresponded to the pattern of fibrin deposition. Secretory activity of IgA in the glandular cells of nasal turbinates was well retained. Only in dilated glandular ductules in nasal polyps was the secretory activity impaired.

The radioallergosorbent test (RAST) in nasal polyposis

The incidence of atopy among 64 adults undergoing polypectomy was 25 per cent. Among these atopic patients it was usual for the polyp IgE level to exceed that in the serum. Similarly, D. pteronyssinus-specific IgE was more commonly identified in polyp fluid by the RAST technique than in serum. However, this was not so for grass pollen-specific IgE, where serum and polyp fluid were equally positive. We conclude that there are atopic and non-atopic polyps.

Loss of secretory activity in the glands of nasal polyps

Secretory activity in the glands of the nasal polyps from 15 patients with or without allergic histories was examined by using a direct (anti-IgA) or indirect (anti-SC) immunofluorescent technique. Glands were found in all the examined nasal polyps, but in many, only a few were present. Active secretory process of IgA was observed in the intraepithelial glands of the ciliated, pseudostratified epithelium. Most of the dilated glandular ductules, on the contrary, appeared to be lacking in secretory activity of IgA. Such were commonly filled with mucus materials and their epithelial glandular cells showed no fluorescence for anti-SC, whereas the active IgA secreting cells showed a heavy fluorescence for secretory component (SC) in indirect immunofluorescent studies. Activity of the glandular ductules, therefore, was determined by examining the SC producing activity. In some extracted polyps, SC containing dilated glands were present. These active glands, however, lost the SC producing activity followed by the stasis of mucus flow in the lumen. Thus, when the glands were occupied by mucus materials, stretched and cystic degeneration ensued.

Simple nasal polyps and allergic manifestations

A series of 74 consecutive patients with simple nasal polyps were interviewed with regards to features of allergy. Skin testing with a variety of antigenic extracts and estimations of peripheral blood immunoglobulins including total serum IgE were also carried out. The simple tests performed in this study have not been able to delineate a specific subgroup of atopic patients with nasal polyps. Positive skin testing with house dust mite extract may form the basis of a clinical evaluation of hyposensitization.

[Demonstration of clusters in nasal polyps a light and electron microscopic investigation (author's transl)]

Numerous functional studies have shown that lymphocytes and macrophages cooperate during the immune response. Cell clusters, consisting mainly of macrophages and lymphoid cells, were found in nasal polyps in humans, especially the oedematous type. Within the clusters the cells showed close physical contact brought about by microvilli of varying length, suggestive of cellular cooperation. These cell clusters resemble the formations found in vitro and in vivo during immunization procedures.

[Long-term treatment of nasal polyps with beclomethasone dipropionate aerosol. III. Morphological studies and conclusions]

Morphological studies during the treatment of patients with nasal polyps with beclomethasone dipropionate aerosol for one year showed a trend towards a decrease in the number of eosinophils in nasal smears and falls in the increased concentrations of albumin, IgG and IgE in the nasal secretion. No change in the histological picture of the polypous tissue except increased density was observed. By scanning electron microscopy, no change in the surface structure of the nasal mucous membrane was noted. As morphological studies did not reveal any sign of adverse effects, beclomethasone dipropionate may be regarded as a valuable drug in the treatment of nasal polyps. The indications for its clinical use and supplementary therapy are discussed.

[Sturcture and function of the mononuclear phagocytic system (MPS) in chronic rhinosinusitis. A light and electron microscopic investigation (author's transl)]

Neither the concept of the Reticulo-Endothelial-System (RES) Aschoff's (1924) nor that of the Reticulo-Histiocyte-System (RHS) provides a satisfactory framework into which the present knowledge of the phagocytic mononuclear cells can be fitted. Current knowledge concerning morphology, histochemistry (peroxydase and esterase activity), immunology (specific surface antigens, receptors on the cell membranes), function (immune phagocytosis, pinocytosis), kinetics (3H-thymidine labelling) and culture makes it possible to place all highly phagocytic mononuclear cells and their precursors in one system, which is called the Mononuclear-Phagocytic-System (MPS) (Langevoort, Cohn, Hirsch, Humphrey, Spector, van Furth, 1969). Kinetic studies with labelled cells have shown, that mononuclear phagocytes originate from precursor cells in the bone marrow (stem cell leads to monoblasts leads to promonocytes), than are circulating in the peripheral blood as monocytes and are transformed to tissue macrophages entering tissues. The MPS comprises following cells in following organs: connective tissue (histiocytes resp. macrophages); liver (Kupffer-cells); lung (alveolar macrophages); lymph nodes (free and fixed macrophages); bone marrow (macrophages); serous cavities (pleural and peritoneal macrophages); bone tissue (osteoclasts?); nervous system (microglial cells) (SEE Table 1). The reticular cells, endothelial cells and fibroblasts (fibrocytes) can therefore not be included in the MPS. Besides differences in morphology, histochemistry and function, they derive from mesenchymal cells and not from the bone marrow as the MPS. The present investigation demonstrates the structure and significance of the MPS in various kinds of chronic-specific and non-specific rhinosinusitis. On semithin sections two kinds of macrophages can be distinguished light-microscopically: 1. Larger macrophages with many phagosomes (storage cells) (Fig. 1A), which can exhibit sometimes a ring-shape on sections embracing greater parts of the interstitium (Fig. 1B). Such forms are mainly found in chronic (maxillary) sinusitis and are interpretated as "scavenger" macrophages. 2. The second type consists of smaller macrophages with extremely ruffling of the cell surface, which is interpretated as an expression of highly (specific?) stimulated states. These later macrophages can be seen mainly in edematous nasal polyps, which might be caused by allergic reactions of the anaphylactic type. The fine structure of the phagocytes is to some extent dependent on the actual development and functional state: there are "immature" macrophages, which are practically indistinguishable from blood monocytes (Fig. 2A); some of them can be stimulated and can therefore show many surface foldings and projections (Fig. 2B). The "mature" macrophage shows a well developed Golgi-area and many secondary lysosomes (Fig. 3). The storage type of the macrophages, which can predominate in some cases of chronic maxillary sinusitis, is characterized by many electron-lucent vacuoles (Fig. 4)...

[Histologic and immunologic study of recurring endonasal polyposis in relation to desensitization therapy]

Ten middle-aged patients (7 males and 3 females) suffering allergic rhinitis and endonasal polyposis, were polypectomized and studied with allergoimmunologic techniques. Clinical evaluation preceded laboratory examinations consisting in routine data and electrophoretic study of serum proteins. These examinations were performed before and after one-year hyposensitization treatment. One patient revealed a hypogammaglobulinemia and received 800 mg of commercial human gammaglobulin every 28 days, during 3 months; subsequent proteinograms showed acceptable improvement of the initial value. Skin tests resulted positive in all patients particularly to house dust, micotic (Candida albicans, Trycophyton and Alternaria) and bacterial antigens (Gram positive and negative bacteria). Specific hyposensitization was performed throughout one year with weekly subcutaneous injections of the corresponding antigens. No autovaccine of nasal exudates was employed. All the polyps were divided into two parts; one half for histological study and the other half stored at -20 degrees C for protein determination using immunoelectrophoresis, polyacrilamide gel and radial immunodiffusion. Immunoelectrophoresis was performed with polyps homo-genate against an antihuman serum and showed two precipitin lines at alfa-1 and beta-1 globulin sites. Polyacrilamide gel revealed more lines in those runs belonging to post-vaccinated polyps than in those belonging to the prevaccinated group. Immunoquant polyps were checked against anti-A, anti-G and anti-M; only IgA was detected in polyps obtained at any time. These apparently contradictory results may be due to the different sensitivity of the techniques applied as well as the small amount of polyps homogenate and its low protein content. New polyps reappeared in three patients at six, ten and twelve months, respectively, from the beginning of the treatment. These patients were again polypectomized and histological and immunological studies were repeated. They were fixed in Bouin, and paraffin sections of 6 to 10 microns in thickness, were submitted to hematoxilineosin, P.A.S. and toluidin blue techniques. These preparations were microscopically evaluated with a Carl Zeiss Photomicroscope with magnifications of 100, 250, 400 and 1,000 times. An important difference between the original and the recurrent histological images was seen. Meanwhile the former polyps were vascularly rich and cellularly poor, the latter appeared inversely composed. An abundant infiltrate of plasmocytes, lymphocytes and histocytes was the rule; it was regularly disposed but a preference to collect around the vessels was observed. The vessels seemed to be lesser in number and size though this observation must be checked with further investigations. The absence of eosinophils led us to support--in this case--the participation of an infectious mechanism in an allergic filed with high sensitivity to bacterial and inhalant antigens...