Local production of antigen-specific IgE in different anatomic subsites of allergic fungal rhinosinusitis patients

Objective: Local production of antigen-specific IgE in allergic fungal rhinosinusitis (AFRS) is likely integral to the expression of allergy. This study examines if there are anatomic variations in local IgE expression or if variations among fungal and nonfungal IgE exist. Study Design: Cross-sectional study. Setting: Tertiary medical center. Subjects and Methods: Specimens from 11 AFRS, 8 chronic rhinosinusitis without nasal polyps (CRSsNP), and 9 control patients underwent immunohistochemical localization for IgE and evaluation for antigen-specific IgE by ImmunoCAP testing. Results: Inferior turbinate (IT) epithelium had greater IgE staining in AFRS than control (P = 0.013) and CRSsNP (P = 0.002). A significant difference was also found at the IT subepithelial level for AFRS compared with controls (P = 0.001) and CRSsNP (P < 0.001). Within AFRS, IgE staining was increased in the subepithelium compared to epithelium (P = 0.003). ImmunoCAP analysis on IT tissue from AFRS and controls demonstrated increased antigen-specific IgE for 5 of 14 antigens (P < 0.05) and total IgE (P < 0.001). There were no significant anatomic differences between IT and sinus IgE staining. Conclusion: More fungal and nonfungal IgE is expressed in IT and sinus tissues of AFRS patients, as compared with control and CRSsNP patients.