Albumin and immunoglobulin levels in nasal secretions of patients with nasal polyps treated with endoscopic sinus surgery and topical corticosteroids.

BACKGROUND

Nasal polyposis is principally treated by surgery, which may be combined with administration of topical corticosteroids to postpone or prevent recurrences.

OBJECTIVE

In this study endoscopic sinus surgery and subsequent use of topical corticosteroids (budesonide) for 1 year was evaluated.

METHODS

Clinical data of 41 patients with nasal polyps were evaluated, and their nasal secretions were compared with those of 26 healthy persons (control subjects).

RESULTS

The patients had much higher initial total protein, albumin, IgM, secretory IgA (S-IgA) (p < 0.001 for all), and IgG concentrations (p < 0.05) than the control subjects. Treatment resulted in a significant decrease of S-IgA (p < 0.001) within 6 months. IgM and IgG concentrations decreased more slowly (p < 0.001 and p < 0.05 at 1 year, respectively). IgE levels decreased, but we could not demonstrate significance. Relative to total protein levels, the albumin and S-IgA levels decreased within 6 months (p < 0.005 and p < 0.001, respectively). The excretion of all proteins remained higher in patients than in the control subjects, even after 1 year of topical corticosteroid treatment. Clinical evaluation showed slightly higher S-IgA levels in patients with an IgE-mediated allergy than in those without such a condition, and the recurrence rate was highest in the former group (75% vs 48%).

CONCLUSIONS

The data support the hypothesis that inflammatory reactions in the nasal mucosa play a role in the pathogenesis of nasal polyps but also suggest an additional causative factor.