Nasal polyp IgE and IgG4 levels are elevated in aspirin-exacerbated respiratory disease
Sunday, March 4, 2018: 4:30 PM
South Hall A2 (Convention Center)
Kathleen M. Buchheit, MD, Howard Katz, PhD, Katherine C. Murphy, Juying Lai, Neil Bhattacharyya, MD, Joshua A. Boyce, MD FAAAAI, Tanya M. Laidlaw, MD FAAAAI
RATIONALE: The cause of nasal polyposis in aspirin-exacerbated respiratory disease (AERD) is unknown. Tissue B-cell activation and elevated antibody levels have been reported in nasal polyposis, but have never specifically been investigated in AERD. We sought to investigate the presence and clinical relevance of local antibody production in AERD.

METHODS: Sinus tissue specimens were obtained from subjects with AERD, aspirin-tolerant chronic rhinosinusitis with nasal polyps (CRSwNP), chronic rhinosinusitis without nasal polyps (CRSsNP), and healthy controls. Tissue immunoglobulin levels and antibody secreting cells were quantified via ELISA and immunohistochemistry. Th2 cytokine mRNA levels were quantified with qPCR. Nasal polyp antibody levels were correlated with markers of disease severity.

RESULTS: Total tissue IgE and IgG4 levels were higher in subjects with AERD as compared to healthy controls, CRSsNP, and aspirin-tolerant CRSwNP (p < 0.01 for IgE and p < 0.001 for IgG4). Total IgG and IgE levels positively correlate with the number of polyp surgeries for each subject (r= 0.48, p <0.05 and r= 0.38, p<0.05 respectively), but did not correlate with subject age. Whole nasal polyp IL-10 mRNA expression was higher in subjects with AERD vs. CRSwNP (p <0.05), but there were no significant differences in IL-4 and IL-13 mRNA expression.

CONCLUSIONS: Our study demonstrates that tissue immunoglobulin levels are elevated in subjects with AERD and correlate with disease severity. In AERD, there are distinct elevations in IgE and IgG4. The IgG4 elevation may be driven in-part by IL-10 production as IL-10 can shift the balance between IgE and IgG4 production to favor IgG4 production.