Tissue Eosinophilia Research Articles

Circulating BAFF as novel biomarker in distinguishing chronic rhinosinusitis with nasal polyps endotypes and predicting postoperative recurrence

BackgroundB cell-activating factor (BAFF) is a proinflammatory cytokine involved in inflammatory and allergic diseases, but its role in chronic rhinosinusitis with nasal polyps (CRSwNP) remains unclear. This study aims to explore the predictive value of circulating BAFF in CRSwNP endotypes and postoperative recurrence. MethodsWe recruited 120 CRSwNP patients, including 68 non-eosinophilic CRSwNP (neCRSwNP) patients, 52 eosinophilic CRSwNP (CRSwNP) patients, and 60 healthy controls (HCs). Circulating BAFF levels of all participants were measured by enzyme-linked immunosorbent assay (ELISA), and receiver-operating characteristic (ROC) and logistic regression analyses were applied to assess the predictive ability of BAFF levels in distinguishing CRSwNP endotypes. All CRSwNP patients were followed for more than 3 years, and the predictive value of circulating BAFF for postoperative recurrence was evaluated. ResultsSerum BAFF levels were elevated in CRSwNP patients compared with the HCs (P < 0.01) and significantly higher in eCRSwNP patients. The increased serum BAFF concentrations positively correlated with blood eosinophil counts and percentages, tissue eosinophil counts, and serum total IgE (P < 0.05). The ROC curve showed that serum BAFF exhibited strong discriminative ability for eCRSwNP. Finally, 99 CRSwNP patients completed the follow-up schedule, 65 patients were classified into non-recurrence group and the other 34 patients were categorized into recurrence group. Serum BAFF levels were significantly higher in recurrence group than non-recurrence group (P < 0.001), and the ROC curve suggested a high predictive value of serum BAFF in predicting postoperative recurrence. Moreover, logistic regression and Kaplan-Meier curves showed that serum BAFF was an independent risk factor for postoperative recurrence (P < 0.05). ConclusionOur data suggested that serum BAFF levels were upregulated in CRSwNP patients and correlated with mucosal eosinophil infiltration severity. Serum BAFF seemed to be a novel biomarker for preoperatively distinguishing CRSwNP endotypes and predicting postoperative recurrence.

Co-Expression and Localization of Angiotensin-Converting Enzyme-2 (ACE2) and the Transmembrane Serine Protease 2 (TMPRSS2) in Paranasal Ciliated Epithelium of Patients with Chronic Rhinosinusitis

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses angiotensin-converting enzyme-2 (ACE2) and the transmembrane serine protease 2 (TMPRSS2) as a primary receptor for invasion. Cell entry by the virus requires the co-expression of these molecules in the host cells. We investigated ACE2 and TMPRSS2 expression and localization in paranasal epithelium of eosinophilic chronic rhinosinusitis (ECRS) patients (n = 38), non-ECRS (n = 31), and healthy controls (n = 25). CRS inflammatory patterns are characterized by the type of cytokines; we investigated whether inflammatory endotypes are associated with cell-entry molecules, as this could be linked to susceptibility to SARS-CoV-2 infection. The ACE2, TMPRSS2, and other inflammatory cytokine mRNA levels were assessed by quantitative RT-PCR. The localizations of ACE2- and TMPRSS2-positive cells were examined with immunofluorescent double-staining using laser scanning confocal microscopy (LSCM). The non-ECRS patients showed significantly increased ACE2 and TMPRSS2 mRNA expressions compared to the ECRS patients. The CRS patients' ACE2 and TMPRSS2 mRNA levels were positively correlated with IFN-γ (r = 0.3227 and r = 0.3264, respectively) and TNF-α (r = 0.4008, r = 0.3962, respectively). ACE2 and TMPRSS2 were negatively correlated with tissue eosinophils (r = -0.3308, r = -0.3112, respectively), but not with IL-13. ACE2 mRNA levels were positively correlated with TMPRSS2 (r = 0.7478). ACE2 and TMPRSS2 immunoreactivities were localized mainly in the epithelial ciliated cells, as confirmed by co-staining with TMPRSS2 and acetylated α-tubulin, a cilia organelle marker. Using LSCM imaging, we observed higher expressions of these molecules in the non-ECRS patients versus the ECRS patients. ECRS patients with type 2 inflammation showed decreased ACE2 and TMPRSS2 expressions in their sinus mucosa. ACE2 and TMPRSS2 regulation seems to be positively related to IFN-γ and TNF-α production in CRS patients; ACE2 and TMPRSS2 were co-expressed in the ciliated epithelium of their paranasal mucosa, implicating the paranasal epithelium as a portal for initial infection and transmission.

Major basic protein deposited at intra mucosal epithelium with probable eosinophilic chronic rhinosinusitis.

BackgroundEosinophilic chronic rhinosinusitis (ECRS) is diagnosed by Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) scoring system and histopathological eosinophil counts of dissected nasal polyps. Patients with low JESREC score and small number of tissue eosinophils are diagnosed with non-ECRS (NECRS). Due to the 2 parameters of this diagnostic system, chronic rhinosinusitis is to be divided to 4 groups and some patients fall into the 2 groups other than ECRS and NECRS: probable ECRS (pECRS) and probable non-ECRS (pNECRS). We attempted to clarify clinical and histopathological similarities and differences, especially concerning major basic protein (MBP), among those groups.MethodsOne hundred twenty-eight patients treated by endoscopic sinus surgery was included. Clinical characteristics were compared among each group, and immunohistological analysis for MBP was performed to 35 randomly selected patients. MBP deposition at intra mucosal epithelium was evaluated by semiquantificational approach.ResultsECRS patients showed significantly higher comorbidity rate with allergic rhinitis (36 patients, 78.3%), asthma (36 patients, 78.3%) compared with other groups. Also, percentage of the patients complaining olfactory dysfunction (42 patients, 91.3%) was significantly higher (p < 0.001). Lund-Mackay score (mean, 14.5; 6–24) and recurrence rate (27 patients, 61.4%) was the highest in ECRS patients. Regarding pECRS, the number of patients with olfactory dysfunction (5 patients, 55.6%) was higher than pNECRS and NECRS groups. Also, comorbidity of asthma and percentage of blood eosinophils tended to be higher than those 2 groups. MBP score of pECRS group was significantly higher than NECRS (p < 0.05), despite of smaller tissue eosinophil counts.ConclusionpECRS might share some characteristics with ECRS although tissue eosinophil count was significantly smaller compared with ECRS. The results of this study have shown that MBP score in pECRS nasal polyps was significantly higher than NECRS patients and close to ECRS. That might suggest that eosinophils have existed in the nasal polyps of pPECRS patients at some point before surgery.

Эозинофильный гастрит у ребенка. Как заподозрить? Критерии диагностики

Objective of the Review: To analyze current data on eosinophilic lesions of the stomach in children with the analysis of a clinical case. Key points. Diseases of the gastrointestinal tract associated with primary tissue eosinophilia are a heterogeneous group of changes characterized by inflammation, with predominantly eosinophilic tissue infiltration in the absence of other known causes. Clinical manifestations of allergic inflammatory diseases of the gastrointestinal tract are most often nonspecific. Depending on the level of the lesion, eosinophils are distinguished: gastritis (EoG), enteritis, and colitis. In recent years, more and more attention of experts has been directed to research in this area, but so far there are no general epidemiological data on the prevalence of this pathology in the population, both adults and children. Conclusion. Currently, there are no clear morphological criteria for diagnosing eosinophilic lesions of the stomach, small and large intestine in children, and clinical manifestations, especially in young children, are nonspecific. When making a diagnosis of EoG, it is necessary to take into account a family allergic history, a set of laboratory diagnostic data (eosinophilia in a clinical blood test and a high level of total IgE) and a morphological study of a biopsy of the gastric mucosa. Keywords: children, eosinophilic gastritis, eosinophilia, tissue eosinophilia, food allergy.

Surgical repair of umbilical hernia in a patient with Churg–Strauss syndrome under regional anaesthesia

Churg–Strauss syndrome (CSS), also referred to as eosinophilic granulomatosis with polyangiitis, is characterised by asthma, peripheral and tissue eosinophilia, extravascular granuloma formation and vasculitis of multiple organ systems. Patients with CSS have higher risk for hyper-reactive airway disease. Administering general anaesthesia in such patients may be deleterious as it requires airway manipulation, use of muscle relaxants some of which are associated with release of histamine and use of anti-cholinesterases which can cause bradycardia, increased secretions and bronchial hyper-reactivity. We report a case of a 36-year-old male with known CSS presented with umbilical hernia for mesh repair which was managed with regional anaesthesia.

Tumour Associated Tissue Eosinophilia in Oral Squamous Cell Carcinoma by Special Histochemical Analysis of Tissue Eosinophilia using Congo Red Staining

Introduction: Tumour Associated Tissue Eosinophilia (TATE) is an important phenomenon occurring in the tumour microenvironment and has a pivotal role. TATE is defined as “eosinophilic stromal infiltration of a tumour not associated with tumour necrosis or ulceration”. The exact role of TATE in malignancies is yet unclear but studies have shown that TATE usually has a favourable outcome in head and neck Squamous Cell Carcinoma (SCC). Therefore, more studies are needed to substantiate this data. Aim: To compare TATE between normal epithelium and Oral Squamous Cell Carcinoma (OSCC) and compare TATE between the histological grades of OSCC. Materials and Methods: A retrospective study was conducted at Dr. BR Ambedkar Medical College, Bangalore, Karnataka, India, from June 2019-January 2021 which included 50 cases, 10 from normal mucosa and 40 histopathologically diagnosed cases of OSCC. 1% congo red solution was used to stain 4 μm thick sections. The sections were examined at a high magnification (40X) and 10 microscopic fields were examined in succession for eosinophils. The average number of eosinophils observed were compared using univariate analysis, which included the Analysis of Variance (ANOVA) test and the Chi- square test and a p-value of 0.001 was considered statistically significant. Results: The mean value of tissue eosinophils increased in OSCC compared to normal mucosa, according to present study findings. When comparing different grades of carcinoma, statistical analysis revealed that well differentiated squamous cell carcinoma had a greater TATE than other grades, which was statistically significant (p-value &lt;0.001). Conclusion: The higher eosinophil count in well differentiated OSCC compared to the other grades could be associated with a better clinical outcome for the patient. In OSCC, TATE can be utilised as a predictor of a good prognosis.

Angiolymphoid hyperplasia with eosinophilia of the palate: A case report with literature review

Angiolymphoid hyperplasia with tissue eosinophilia (ALHE) is a rarely occurring benign vascular tumor of unknown etiology and most commonly affecting the head and neck region. It usually presents clinically as brownish or purplish papules or nodules with major prevalence in females. As the name defines, histologically it shows proliferating endothelial cells and lymphoid aggregates with stromal eosinophilia. It is very rarely identified clinically and the diagnosis is purely based on histopathology. This is a unique case report of intraoral ALHE with an unusual clinical appearance as ulceroproliferative lesion that showed quick remission after incisional biopsy.

Dexpramipexole: A Potential Non-biologic Alternative for Patients with Eosinophilic Asthma?

Dexpramipexole offers a potential non-biologic option for patients with eosinophilic asthma in that it lowers blood eosinophil count and improves lung function parameters. However, longer-term studies in patients treated by reducing blood or tissue eosinophils, whether through biologics or oral therapies, are needed to better understand the role of the eosinophil in human biology and disease pathogenesis and to better delineate the clinical efficacy of Dexpramizole in asthma.

Kimura Disease with Colli Dextra Tumor Manifestation: A Case Report

Abstract Kimura disease (KD) is a rare chronic inflammatory disease characterized by a triad of painless head and subcutaneous neck masses with regional lymphadenopathy, tissue and serum eosinophil infiltration, and elevated serum immunoglobulin E (IgE). It is a benign condition of unknown aetiology that usually affects young Asian men.1,2 We report a case of a 19-year-old woman with a neck lump for the past 3 months said to be enlarged. A less characteristic manifestation with a rare prevalence, Kimura disease, can be considered a differential diagnosis in a colli tumour. In this case, it was established after histopathological biopsy. Treatment for Kimura disease is still under observation in several studies. The treatments that have been tested include surgery, radiotherapy, and administration of corticosteroids and immunosuppressants, or a combination. In this case, surgical therapy was initiated, followed by steroids and radiotherapy.

Eosinophilic Gastritis Mimicking Mucosa-Associated Lymphoid Tissue Lymphoma.

Eosinophilic Gastritis Mimicking Mucosa-Associated Lymphoid Tissue Lymphoma.

Clinical profile and characteristics of eosinophilic esophagitis patients presenting with refractory gastroesophageal reflux disease in Makassar, Indonesia.

Refractory Gastroesophageal Reflux Disease (GERD) is a typical GERD that does not respond to Proton Pump Inhibitor (PPI) treatment for 8-12 weeks. One of the differential diagnoses for refractory GERD is eosinophilic esophagitis which is characterized by eosinophilic infiltration into the esophagus endothelium. However, to date, eosinophilic esophagitis is still poorly understood and data is still limited. The aim was to describe the profile and characteristics of patients with eosinophilic esophagitis presenting with refractory GERD in Makassar, Indonesia. This descriptive study involved patients with refractory GERD from two hospitals. In addition to basic demographic data, history, and body mass index, all subjects underwent peripheral blood tests to measure eosinophil level and flexible esophagoscopy, from which esophageal biopsy was done to assess the tissue eosinophil level. Eosinophilic esophagitis was established based on the examination of >15 eosinophils/high power field. Out of 32 subjects, two subjects were diagnosed with eosinophilic esophagitis (6.3%). Both subjects were male with normal BMI in the age range of 36-55 years and none had peripheral blood eosinophilia. Symptoms of eosinophilic esophagitis were similar to refractory GERD. Peripheral blood eosinophilia was not associated with incidence of eosinophilic esophagitis.

Quantification of Mucosal Eosinophils for the Histopathologic Diagnosis of Eosinophilic Gastritis and Duodenitis: A Primer for Practicing Pathologists.

Eosinophilic gastrointestinal diseases, specifically eosinophilic gastritis and duodenitis, are chronic inflammatory conditions characterized by persistent gastrointestinal (GI) symptoms and elevated levels of activated eosinophils in the GI tract. Both clinical and endoscopic findings are nonspecific, no clinical or histopathologic diagnostic guidelines are published, and disease awareness is low, both among clinicians and amongst pathologists, who tend to overlook mild or moderate increases in the density of eosinophils in GI biopsy specimens. Yet, evaluating and, at times, counting eosinophils in GI biopsies may have important clinical implications: the numbers of tissue eosinophils correlate with clinical manifestations, can be used as determinants of effective management, and are used to assess the effects of treatment. A most persuasive argument for providing a count rather than a value judgment is that patients read reports, understand numbers, and use them to help to understand the course of their disease. The objective of this primer is to provide pathologists with the tools to incorporate a quantitative assessment of eosinophilia in the diagnosis of gastric and duodenal biopsy specimens and to develop a systematic approach to their evaluation, counting, and reporting. To achieve this aim, we present our general approach to the biopsy (where to count), followed by details on the characteristics of a countable eosinophil (what to count), and provide with a set of suggestions on the counting methods (how to count). We conclude with suggestions on how to report GI tissue eosinophilia in a manner that alerts clinicians and prompts pertinent management steps.

Correlation between Peripheral Blood Eosinophilia and the Histopathological Changes in Nasal Mucosal in Chronic Rhinosinusitis

Background: Chronic rhinosinusitis(CRS) has emerged as one of the major causes of significant morbidity in otorhinolaryngology, as it is often noted to be refractory to medical management and has a tendency to recur post-surgery. Limited research has shown that peripheral eosinophilia is related to the presence of nasal polyps, the extent of the mucosal disease, the severity of tissue eosinophilia, and the risk of recurrence.&#x0D; Aim: This study aimed to establish the significance of peripheral blood eosinophilia, both differential (EC) and absolute eosinophil counts (AEC) - in adult CRS, to correlate the tissue eosinophilia and peripheral blood eosinophilia, and compare the observations in the two types of CRS with nasal polyp and without nasal polyp.&#x0D; Material and Methods: A total of 50 adult patients with CRS who underwent FESS were included in the study and were divided based on the presence (Group 1) or absence (Group 2) of peripheral blood eosinophilia.&#x0D; Results: There were equal number of cases of chronic rhinosinusitis with nasal polyp (CRSwNP) and without polyp (CRSsNP); 25 each. With regard to clinical features, Group 1 had a higher number of cases with nasal obstruction (p-value = 0.023), post-nasal drip (p-value = 0.035), and hyposmia (p-value = 0.021) when compared to Group 2. On histopathology, Group 1 had more areas of edema (p-value = 0.027), and mucous gland hyperplasia (p-value = 0.013) while Group 2 had prominent lymphoplasmacytic infiltrates (p-value = 0.035), neutrophilia (p-value = 0.047), and tissue infiltration of macrophages (p-value = 0.027). Tissue eosinophilia was present in 32 out of the total cases; 20 (71.43%) in Group 1 and 12 (53.33%) in Group 2. The group with tissue eosinophilia had significantly higher eosinophil count (9.24 ± 4.26% vs 5.32 ± 2.9%; p-value &lt; 0.01) as well as AEC (823.335 ± 434.357/µl vs 485.128 ± 285/µl. 907; p-value &lt; 0.01).&#x0D; Conclusion: The study demonstrated that CRS cases with tissue eosinophilia exhibit an elevated peripheral eosinophil count when compared to non-eosinophilic CRS.

Diagnostic approach to eosinophilia in children

Hematopoiesis is the process which maintains lifelong production of haemopoietic (blood) cells from bone marrow. Blood consists of three types of cells (Erythrocyte – Leukocytes - palates), and plasma. Leukocytes are divided into 2 types of granulocytes (including neutrophils, eosinophils and basophils); and agranulocytes (including lymphocytes and monocytes). Eosinophil attack and kill parasites and cancer cells, and help with allergic responses, so their role is to protect the body from bacteria and parasites. They are found in the peripheral blood and also tissue, so they are closer to where the site of infection may occur. The eosinophil is a much-overlooked cell, more usually considered as a curious form of phagocytic leucocyte with functions similar to its more numerous cousins, the neutrophil. However, a dramatic blood and tissue eosinophilia is an important part of adaptive immunity to parasitic helminthic infections, whilst more detrimentally, the eosinophil is thought to make a major contribution to the inflammation underlying the pathogenesis of disorders such as asthma, allergic rhinitis and atopic dermatitis .[1]. Eosinophilia is a common finding in clinical practice and presented in a broad spectrum of diseases, some of them hematologic disorders and others non – hematologic (infection disease – allergic disease – medication reaction, and autoimmune disease). Key words: eosinophilia, children, diagnostic approach

Immunopathologic characteristics of Chinese pediatric patients with chronic rhinosinusitis

BackgroundThe histopathology of pediatric chronic rhinosinusitis with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP) is rarely reported due to low prevalence or the unavailability of tissue samples. Hence, we aimed to characterize and compare the histologic features and protein expression of Th1/Th2/Th17-related cytokines in pediatric CRSsNP and CRSwNP. MethodsThe histologic characteristics of 15 children with CRSsNP, 52 children with CRSwNP, and 12 control participants were analyzed using hematoxylin and eosin staining. The expression of Th1/Th2/Th17-related cytokines were examined using immunohistochemistry and the enzyme-linked immunosorbent assay. ResultsPediatric subjects with CRSwNP had more intact epithelium and less submucosal mucous glands compared to those with CRSsNP. Tissue eosinophils were more prevalent in the younger CRSwNP group compared to the older CRSwNP or the CRSsNP groups. The protein concentrations of Th2 cytokines were significantly higher in the CRSwNP group than the CRSsNP group or the control group. Moreover, the protein concentrations of Th17 cytokines were significantly higher in the younger CRSwNP group than the older CRSwNP group or the CRSsNP and control groups. The protein concentrations of Th1 and Th17 cytokines were also significantly higher in the CRSsNP group than the control group. Compared with non-eosinophilic CRSwNP, eosinophilic CRSwNP presented with elevated protein concentrations of Th1 and Th17 cytokines. ConclusionFor the first time, we showed that pediatric CRSwNP presents as eosinophilic with Th2/Th17 inflammation, whereas CRSsNP presents as Th1/Th17 inflammation. Our study may provide a theoretical basis for the precise treatment of pediatric CRS in the future.

The protective effects of human milk components, 2′-fucosyllactose and osteopontin, against 2,4-dinitrochlorobenzene-induced atopic dermatitis in mice

Atopic dermatitis (AD) is a chronic inflammatory skin disease with high morbidity in infants. Several bioactive components of human milk, such as 2′-fucosyllactose (2′-FL) and osteopontin (OPN), are reported to exhibit anti-inflammatory properties. This study determined that oral administration of 2′-FL and OPN significantly attenuated the 2,4-dinitrochlorobenzene (DNCB)-induced AD symptoms in BALB/c mice. 2′-FL and OPN treatment markedly downregulated the serum IgE level and decreased the numbers of mast cells and eosinophils in the dermal tissues from DNCB-sensitized mice. Interestingly, we found that the combination of OPN with 2′-FL produced a great therapeutic effect on AD in mice. Additionally, the result showed that the components suppressed Th2 response, resulting in an attenuated cutaneous inflammatory response. Furthermore, in vitro study validated that 2′-FL and OPN inhibited Th2 cells differentiation. Together, we conclude that 2′-FL and OPN ameliorates DNCB-induced AD-like skin inflammation, and its supplement might help to prevent AD in infants.

47-Year-Old Woman With Bilateral Flank Pain

47-Year-Old Woman With Bilateral Flank Pain

2021 year in review: Spotlight on eosinophils

This review highlights recent advances in the understanding of eosinophils and eosinophilic diseases, particularly eosinophilic gastrointestinal diseases during the last year. The increasing incidence of diseases marked by eosinophilia has been documented and highlighted the need to understand eosinophil biology and eosinophilic contributions to disease. Significant insight into the nature of eosinophilic diseases has been achieved using next-generation sequencing technologies, proteomic analysis, and machine learning to analyze tissue biopsies. These technologies have elucidated mechanistic underpinnings of eosinophilic inflammation, delineated patient endotypes, and identified patient responses to therapeutic intervention. Importantly, recent clinical studies using mAbs that interfere with type 2 cytokine signaling or deplete eosinophils point to multiple and complex roles of eosinophils in tissues. Several studies identified distinct activation features of eosinophils in different tissues and disease states. The confluence of these studies supports a new paradigm of tissue-resident eosinophils that have pro- and anti-inflammatory immunomodulatory roles in allergic disease. Improved understanding of unique eosinophil activation states is now poised to identify novel therapeutic targets for eosinophilic diseases.

Association Between Serum Amyloid A Expression and Disease Control after Endoscopic Sinus Surgery in Patients With Chronic Rhinosinusitis With Nasal Polyps.

Our previous study revealed that serum amyloid A (SAA) levels in polyp tissues could serve as a biomarker for the prediction of corticosteroid insensitivity in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). However, their association with disease control status in the patients after endoscopic sinus surgery remains to be assessed. Polyp tissues and control uncinate process mucosa were collected from 48 patients with CRSwNP and 10 healthy control subjects. SAA expression was examined using immunohistochemistry and enzyme-linked immunosorbent assay. Receiver operating characteristic (ROC) curves were performed to determine the predictive value of SAA in nasal polyps. The clinical characteristics of 2 CRSwNP subtypes (SAAhigh and SAAlow) were evaluated. The SAA expression levels in polyp tissues were significantly elevated both in non-eosinophilic and eosinophilic CRSwNP as compared to the healthy controls. In patients with CRSwNP, the tissue SAA level was significantly higher in the disease-controlled patients than those of the partly controlled and uncontrolled. ROC curve analysis revealed that a cut-off value of 114.9ng/mL for the tissue SAA level predicted the patients with disease-controlled status with 93.33% sensitivity and 63.64% specificity (AUC = .8727, P < .001). Furthermore, The SAAhigh subgroup showed higher tissue eosinophil numbers and percentage of the disease-controlled patients compared to the SAAlow subgroup. Our findings suggest that measurements of SAA in polyp tissues may provide useful information for evaluating CRSwNP conditions, especially identifying the CRSwNP patients with disease-controlled status after endoscopic sinus surgery.

Shin’iseihaito (Xinyiqingfeitang) extract ameliorates ovalbumin-induced murine allergic rhinitis by regulating cytokines

Shin'iseihaito (Xinyiqingfeitang) is a formula of traditional Japanese Kampo medicine and traditional Chinese medicine (TCM) and for chronic sinusitis. However, the precise action mechanism has been unknown. We examined the effect of shin'iseihaito extract (SSHT) on murine allergic rhinitis model using ovalbumin (OVA). We decocted the mixture of 9 crude drugs in water to prepare SSHT. SSHT (20 times amount of human dose) was orally administered to mice treated with OVA. After mice were sacrificed on day 28, immunoglobulin (Ig) E, interleukin (IL)-4, IL-13, interferon (IFN)-γ, and thymic stromal lymphopoietin (TSLP) levels in nasal lavage fluid samples were measured by enzyme-linked immunosorbent assay (ELISA). The pathological tissue sections from the nasal epithelial mucosa were histopathologically investigated by optical and scanning electron microscopies. We also investigated the effects of modified SSHTs prepared by removing one crude drug from shin'iseihaito to clarify the active ingredients. SSHT suppressed IgE, IL-4, IL-13, and TSLP levels, while increased the IFN-γ levels in OVA-induced allergic mice. Sensitization with OVA resulted in an increase in eosinophilia and goblet cells in murine nasal cavity tissue in comparison with those in untreated group, however, those were significantly reduced by the treatment with SSHT. The extracts of 8 crude drug's mixtures except for the removal of Gypsum fibrosum (GF) from shin'iseihaito counteracted on the suppressive effects of SSHT on IgE, IL-4, IL-13, and TSLP levels in nasal lavage fluid. Our result demonstrated that SSHT may contribute to inhibit the exacerbation of OVA-induced murine allergic rhinitis by regulating cytokines, and the components except for GF contributed anti-allergic effect of shin'iseihaito.