Immunopathogenesis of Chronic Rhinosinusitis and Nasal Polyposis

Robert P. Schleimer*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

163 Scopus citations

Abstract

Chronic rhinosinusitis (CRS) is a troublesome, chronic inflammatory disease that affects over 10% of the adult population, causing decreased quality of life, lost productivity, and lost time at work and leading to more than a million surgical interventions annually worldwide. The nose, paranasal sinuses, and associated lymphoid tissues play important roles in homeostasis and immunity, and CRS significantly impairs these normal functions. Pathogenic mechanisms of CRS have recently become the focus of intense investigations worldwide, and significant progress has been made. The two main forms of CRS that have been long recognized, with and without nasal polyps, are each now known to be heterogeneous, based on underlying mechanism, geographical location, and race. Loss of the immune barrier, including increased permeability of mucosal epithelium and reduced production of important antimicrobial substances and responses, is a common feature of many forms of CRS. One form of CRS with polyps found worldwide is driven by the cytokines IL-5 and IL-13 coming from Th2 cells, type 2 innate lymphoid cells, and probably mast cells. Type 2 cytokines activate inflammatory cells that are implicated in the pathogenic mechanism, including mast cells, basophils, and eosinophils. New classes of biological drugs that block the production or action of these cytokines are making important inroads toward new treatment paradigms in polypoid CRS.

Original languageEnglish (US)
Pages (from-to)331-357
Number of pages27
JournalAnnual Review of Pathology: Mechanisms of Disease
Volume12
DOIs
StatePublished - Jan 24 2017

Keywords

  • Acantholysis
  • Acanthosis
  • Allergy
  • Chronic rhinosinusitis
  • Eosinophilic inflammation
  • Epithelial barrier
  • Epithelial-to-mesenchymal transition (EMT)
  • Glandular hyperplasia
  • Nasal polyp
  • Sinus disease

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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