Vol.96 No.8 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 96 No.8 August 2003
Clinical and Experimental Studies of Allergic Sinusitis
Yuichi Kurono
(Kagoshima University)
Most patients with allergic rhinitis show a pathological shadow in X-ray examination of the sinuses, despite a lack of infectious symptoms in the nostrils. Such patients are frequently diagnosed with allergic sinusitis, though this disease is not yet well defined. In the present study, the pathogenesis of allergic sinusitis was discussed based on the findings of clinical and experimental investigations of this disease in order to clarify the mechanism of pathology of maxillary sinuses.
Type I allergic response, infection, and natural ostium blockade are considered the chief factors associated with the pathogenesis of allergic sinusitis. When the antigen enters into the sinuses, type I allergic inflammation might occur in the sensitized mucosa. In fact, sinus mucosa obtained from a patient with allergic rhinitis showed remarkable infiltration of eosinophils and edema of the connective layer. However, the sizes of antigens causing type I allergy such as pollen and mites are too large to invade into the sinuses. Since neutrophils are frequently contaminated in nasal as well as sinus secretions, infection seems to be involved in the pathogenesis of allergic sinusitis. Supporting this, there was no significant difference in the concentrations of endotoxin in sinus lavages between allergic sinusitis and the other type of sinusitis. Some patients who underwent septoplasty showed sinus pathology due to nasal packing for two days after surgery, suggesting that natural ostium blockade might induce sinusitis. Partial oxygen pressures in maxillary sinuses were significantly decreased in chronic sinusitis when compared to normal sinuses. Nasal fibroblasts cultured under hypoxic condition produced a large amount of vascular endothelial growth factor which has an enhancing effect on vascular permeability. The findings suggest that many factors other than type I allergic responses might be associated with the pathogenesis of allergic sinusitis.
Key words : allergic sinusitis, type I allergy, natural ostium, hypoxia, VEGF