Chronic rhinosinusitis with nasal polyps: elevated serum immunoglobulin E is associated with Staphylococcus aureus on culture

Background: Recent data has implicated Staphylococcus aureus (SA) superantigen as a potential disease modifier in patients with chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP). The objective of this work was to compare total serum immunoglobulin E (IgE) and serum eosinophils in patients with CRSwNP and CRS without nasal polyps (CRSsNP) based on culture results of the 3 most commonly isolated bacteria. Methods: Retrospective review at a tertiary rhinology referral center of patients with CRS over a 4-year period. Results: Bacterial cultures and immunologic data were obtained from 62 patients with CRSwNP and 34 patients with CRSsNP. SA was the most prevalent bacteria in the CRSwNP group, isolated in 19 patients (31%). Patients with elevated total serum IgE (> 114 IU/mL) were more likely to have SA on culture (p = 0.04) in this population. The percent serum eosinophil levels in the SA + group compared with the SA-group was not significant (6.0 vs 5.1, p = 0.17). Lund-Mackay computed tomography (CT) scores, but not Sino-Nasal Outcome Test 20 (SNOT-20) scores were significantly higher in the SA + vs SA-group (p = 0.03) in patients with CRSwNP. The CRSsNP group demonstrated no difference in IgE or serum eosinophils between different bacterial groups. Conclusion: Our findings suggest that there is an association between SA sinonasal presence and elevated total serum IgE in patients with CRSwNP. In addition, SA + patients had higher Lund-Mackay CT scores, indicating a higher objective burden of disease in this group of patients. (C) 2011 ARS-AAOA, LLC.