Abstract
Cytokine levels in nasal secretions reflect the inflammatory status of the nasal and paranasal sinus mucosa and the development of mucosal disease. The results of previous investigations suggest that macrolide antibiotics can be effective in treatment of chronic rhinosinusitis and nasal polyposis. The aim of this prospective study was to compare the immunomodulatory and clinical effects of long-term low-dose macrolide treatment of nonatopic and atopic patients with nasal polyposis. Forty (n = 40) patients with nasal polyposis, 22 allergic and 18 nonallergic were administered clarithromycin (CAM) 500 mg/day single oral dose for eight weeks. We measured the levels of proinflammatory Th1 cytokines TNF-α and IL-1β, Th2 cytokines IL-4, IL-5 and IL-6, and chemokine IL-8 in the nasal fluid samples, before and after treatment, using flow cytometric method. We also scored each of the 40 patients before and after therapy according to nasal symptom score and endoscopic score. Following treatment, we found significantly reduced levels of IL-8 (p<0.01) and TNF-α (p<0.01) in nasal secretions in nonallergic patients. In subjects with nasal polyposis and allergy, we found decreased levels of IL-8 (p<0.01), IL-6 (p<0.05) and IL-1β (p<0.01). Macrolide therapy decreased the size of polyps in 45.45% of nonatopic and in 50% of atopic patients. After macrolide treatment, we found 67.83% patients in nonallergic group and 55.55% patients in allergic group with improved nasal symptoms. Long-term low-dose treatment with CAM was effective in the management of nasal polyposis. Our results showed that macrolide treatment of nasal polyposis have different immunomodulatory and similar clinical effects in allergic and nonallergic patients.
Highlights
Nasal polyposis is a chronic inflammatory disease of the nose and paranasal sinuses mucosa
Nasal polyposis, which is considered to be a subgroup of chronic rhinosinusitis, is defined as inflammation of the nose and the paranasal sinuses characterized by two or more symptoms, one of which should be either nasal blockage/obstruction/congestion or nasal discharge
To investigate the effects of CAM, the patients were asked to assess their symptoms associated with nasal polyposis on the day of the enrollment in the study and within the seven days after the macrolide treatment and to score their symptoms according to Tsicopoulos et al.[7] from 0 to 3: 0 for no symptoms, 1 for mild symptoms, for moderate symptoms, and 3 tor severe symptoms, so that the maximal nasal symptom score is 15
Summary
Nasal polyposis is a chronic inflammatory disease of the nose and paranasal sinuses mucosa. The condition is characterized by protrusion of benign oedematous polyps from the meatus into the nasal cavities. Several mechanisms have been proposed for the formation of nasal polyps. Histopathological studies of the paranasal sinus mucosa in patients with nasal polyposis has demonstrated eosinophilic tissue infiltration. In addition to increased eosinophilic cell infiltration, increased production and expression of a variety of proinflammatory cytokines and chemokines have been demonstrated in nasal polyp epithelium and lamina propria[1]. Clinical as well as experimental studies indicate that nasal polyp formation and growth are activated and perpetuated by an in-
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