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Does immunotherapy reduce the recurrence rate in nasal polyposis?
The Egyptian Journal of Internal Medicine volume 26, pages 60–67 (2014)
Nasal polyposis (NP) is a chronic inflammatory condition with no proved effective long-term treatment and a tendency to recur.
The aim of our study was to evaluate the effect of immunotherapy on the recurrence rate of NP in atopic patients after surgical management and the ability to improve the quality of patients’ lives and decrease their suffering.
Patients and methods
We chose 60 patients (discussion with the patients with respect to the benefits and hazards of the study was performed and informed consents were provided) with bilateral NP (as diagnosed by full history taking, clinical examination, nasal endoscopic examination, and sinonasal computed tomography) who proved to be allergic (by full history taking, clinical examination. skin prick test, serum total IgE, serum-specific IgE). We classified them into three groups: group I included 18 patients who underwent surgical management (functional endoscopic sinus surgery) as a control group, group II included 18 patients who underwent treatment with subcutaneous immunotherapy by gradual up-dosing protocol for inhalant allergens as a second control group, and group III included 20 patients who underwent treatment with subcutaneous immunotherapy for inhalant allergens 6 weeks after surgical treatment.
In the three groups of patients, the sinoNasal Outcom -22 (SNOT-22) scores were significantly decreased (with the minimally important difference greater than 9 points in 17/18 patients in group I, 17/20 patients in group III, and 15/18 patients in group II), denoting significant clinical improvement in the three groups. However, patients treated with surgery and postsurgical immunotherapy reported more improvement, with no significant difference between them, than those treated with immunotherapy alone. Seven (38.9%) patients of group I had recurrence of NP, whereas six (30%) patients of group III had recurrence. On comparison, there was no statistically significant difference between the two groups. In group II, the NP score was declined on immunotherapy alone but did not disappear completely. The timing of recurrence of NP in patients of group I ranged from 7 to 13 months, whereas in group III it ranged from 12 to 16 months.
We found that immunotherapy could help in improving patients’ clinical symptoms and subsequently their quality of life; postoperative immunotherapy in addition can delay the recurrence, although it does not decrease the recurrence rate significantly.
Önerci M. Nasal polyposis. In: Anniko M, Bernal-Sprekelsen M, Bonkowsky V, Bradley P, lurato S, editors. Otorhinolaryngology, head and neck surgery (European manual of medicine). Berlin, Heidelberg, London, New York: Springer-Verlag; 2010. 2.14: 241–248.
Munoz Del Castillo F, Jurado-Ramos A, Fernández-Conde BL, Soler R, Barasona MJ, Cantillo E, et al. Allergenic profile of nasal polyposis. J Investig Allergol Clin Immunol 2009; 19: 110–116.
Munoz Del Castillo F, Jurado-Ramos A, Soler R, Fernández-Conde BL, Barasona MJ, Cantillo E, et al. Fungal sensitization in nasal polyposis. J Investig Allergol Clin Immunol 2009; 19: 6–12.
Verbruggen K, Van Cauwenberge P, Bachert C. Anti-lgE for the treatment of allergic rhinitis – and eventually nasal polyps? Int Arch Allergy Immunol 2009; 148: 87–98.
Maggi E. T cell responses induced by allergen-specific immunotherapy. Clin Exp Immunol 2010; 161: 10–18.
Emani J, Baroody FM. History of nasal polyposis. In: Onerci TM, Ferguson RJ, editors. Nasal polyposis, pathogenesis, medical and surgical treatment. Berlin, Heidelberg: Springer-Verlag; 2010. 1: 1–7.
Bellussi LM, Lauriello M, Passali FM, Passali D. Relapses after surgery and their prevention. In: Önerci TM, Ferguson RJ, editors. Nasal polyposis, pathogenesis, medical and surgical treatment. Berlin, Heidelberg: Springer-Verlag; 2010. 22: 191–198.
Fokkens W, Lund VJ, Mullol J. Position paper on rhinosinusitis and nasal polyps. EAACI Task Force. Rhinol Suppl. 2007; 20, 40.
Mygind N, Lund V. Nasal polyposi. In: Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, Lund VJ, Luxon LM, Watkinson JC, editors. Scott-Brown’s otolaryngology, head and neck surgery. 7th ed. London: Hodder Arnold; 2008. 121: 1549–1559.
Mailing HS, Djurup R. Diagnosis and immunotherapy of mould allergy, VII IgE subclass response and relation to the clinical efficacy of immunotherapy with cladosporium. Allergy 1988; 34: 60–70.
Alshami AS, Aloba O. Liquid phase in vitro allergen IgE assay with situimmobilization. Adv Biol Sci 1988; 74: 191–201.
Jeffery DS, Alexander GC. Acute and chronic sinusiti. In: Lalwani A, editor. Current diagnosis and treatment, otolaryngology — head and neck surgery, 3rd ed. USA: McGraw-Hill; 2012. 15: 291–301.
Canonica GW, Baena- Cagnani CE, Bousquet J, Bousquet PJ, Lockey RF, Mailing H-J, et al. Recommendations for standardization of clinical trials with allergen specific immunotherapy for respiratory allergy. A statement of a World Allergy Organization (WAO) taskforce. Allergy 2007; 62: 317–324.
Collins MM, Loughran S, Davidson P, Wilson JA. Nasal polyposis: prevalence of positive food and inhalant skin tests. Otolaryngol Head Neck Surg 2006; 135: 680–683.
Larsen K, Tos M. The estimated incidence of symptomatic nasal polyps. Acta Otolaryngol 2002; 122: 179–182.
Klossek JM, Neukirch F, Pribil C, Jankowski R, Serrano E, Chanal I, El-Hasnaoui A. Prevalence of nasal polyps in France: a cross-sectional, case–control study. Allergy 2005; 60: 233–237.
Demoly P, Bencherioua A, Crampette L, Dhivert-Donnadieu H, Godard P, Michel F. From allergic rhinitis to sinus diseases (sinusitis/nasal polyps): epidemiologic and experimental links. Rev Mal Respir2000; 17: 925–930.
Krause JH. Computed tomography stage, allergy testing, and quality of life in patients with sinusitis. Otolaryngol Head Neck Surg 2000; 123: 389–392.
Asero R, Bottazi G. Hypersensitivity to molds in patients with nasal polyposis: a clinical study. J Allergy Clin Immunol 2000; 105: 186–188.
Staikūnienė J, Vaitkus S, Japertienė LM, Ryškienė S. Association of chronic rhinosinusitis with nasal polyps and asthma: clinical and radiological features, allergy and inflammation markers. Medicina (Kaunas) 2008; 44: 257–265.
Zeldin Y, Weiler Z, Magen E, Tiosano L, Kidon MI. Safety and efficacy of allergen immunotherapy in the treatment of allergic rhinitis and asthma in real life. Isr Med Assoc J 2008; 10: 869–872.
Krut O, Sommer H, Kronke M. Antibiotic-induced persistence of cytotoxic Staphylococcus aureus in non-phagocytic cells. J Antimicrob Chemother 2004; 53: 167–173.
James LK, Durham SR. Rhinitis with negative skin tests and absent serum allergen-specific IgE: more evidence for local IgE? J Allergy Clin Immunol 2009; 124: 1012–1013.
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El-Samny, T.A., Ezzat, W.F., Ashour, Z.A. et al. Does immunotherapy reduce the recurrence rate in nasal polyposis?. Egypt J Intern Med 26, 60–67 (2014). https://doi.org/10.4103/1110-7782.139532