Immunoglobulin E to staphylococcal and streptococcal toxins in patients with chronic sinusitis/nasal polyposis

Background: The role of infectious agents and their contribution to the inflammation in chronic sinusitis/nasal polyposis (CS/NP) is not clear. Staphylococcal and streptococcal toxins have superantigen activity and have been implicated in inflammatory conditions such as atopic dermatitis, psoriasis, and asthma. Objective: We investigated the presence of immunoglobulin (Ig)E antibodies to staphylococcal and streptococcal toxins in the serum of individuals with CS/NP. Method: IgE antibodies to staphylococcal exotoxins, A,B, and toxic shock syndrome toxin-1 and streptococcal. pyrogenic exotoxin A, B, and C were measured in 23 individuals with CS/NP before functional endoscopic sinus surgery and in controls (7 atopic and 6 nonatopic) individuals without chronic sinusitis. Presence of IgE to the toxins was also correlated with disease severity on sinus computed tomography (CT) scans. Results: Staphylococcal and streptococcal toxin specific IgE antibodies were detected in 18 of 23 (78%) and 7 of 21 (33.3%) patients, respectively. None of the controls had IgE to the staphylococcal or streptococcal toxins (P < .0001). There was no association between radiographic severity of sinus disease and the presence of IgE antibody to the toxins. Conclusion. A significantly greater proportion of CS/NP patients had IgE to staphylococcal or streptococcal toxins. Evidence of IgE antibodies directed against staphylococcal and streptococcal toxins in the sera of patients with CS/NP suggests a potential role of these toxins with established superantigen effects in the pathogenesis of CS/NP.