Diferencias en la sensibilización a aeroalergenos en pacientes con poliposis nasosinusal

Introduccion: La poliposis nasosinusal (PN) es una enfermedad inflamatoria cronica de la mucosa. Apoyado en los hallazgos clinicos, histologicos e inmunologicos, se postula a la alergia como un factor etiopatogenico, lo cual no ha sido plenamente demostrado. Objetivo: Evaluar la presencia de hipersensibilidad a aeroalergenos en pacientes con PN y compararla con pacientes normales. Material y metodo: Se realizo prick test a aeroalergenos a todos los pacientes utilizando 30 alergenos frecuentes en el area metropolitana de Santiago, incluyendo polenes de arboles, malezas y pastos, acaros, epitelio de animales y hongos habituales. Este test se amplio con el uso de tres hongos habitualmente no evaluados (Stemphyllium, Pullularia, Helminthosporium). Se utilizo la prueba de Chi cuadrado con una significancia de 0,05. Resultados: El 71 por ciento de los pacientes con PN (n =73) y el 66 por ciento del grupo control (n =44) presentaban un test cutaneo positivo, sin diferencia estadistica significativa. El patron de sensibilizacion a aeroalergenos fue similar, salvo para los alergenos fungicos: los pacientes con PN estaban sensibilizados en 40 por ciento a Pullularia, 30 por ciento a Stemphyllium, y 10 por ciento a Helminthosporium. En tanto que los controles no presentaron sensibilizacion a estos hongos no habituales. Discusion y conclusiones: Existe una alta tasa de sensibilizacion a aeroalergenos en pacientes normales y con PN, lo que sugiere un probable rol de la alergia en la patogenesis de la poliposis nasal. Destaca un patron diferente de sensibilizacion a alergenos fungicos, cuya relevancia clinica debe ser evaluada a futuro. Introduction: Nasal polyposis (NP) is a chronic inflammatory disease that leads to tissue oedema and eventually polyps. The pathogenesis of NP has not been fully understood yet, but there are clinical, histological, and immunological findings that suggest that allergy plays a role. Aim: The aim of this study was to find out the prevalence of airborne allergen hypersensitivity in patients with nasal polyposis. Material and method: Skin prick test (SPT) was performed to patients with NP and to a control group (CRS). Thirty frequent airborne allergens of the Santiago de Chile metropolitan area, including tree, grass and weed pollens, house dust mites, animal dander and common fungal allergens were tested. This SPT was extended by using three fungal allergens that usually are not evaluated (Stemphyllium, Pullularia, Helminthosporium). Chi square test was used to compare both groups of patients. Results: 71 percent of NP patients (n=73) versus 66 percent of the controls (n=44) had a positive SPT, although there was no statistical significance. The only difference in sensitization was for fungal allergens. In NP patients, sensitization to Pullularia was about 40 percent>, 30 percent> to Stemphyllium, and 10 percent to Helminthosporium. CRS patients were not sensitized to uncommon fungal allergens. Conclusions: We found a high frequency of sensitization to airborne allergen in CRS and NP patients that suggest a probable role of allergic inflammation in the pathogenesis of nasal polyposis. Stands out a different pattern of sensitization to fungal allergens in the NP group; the clinical relevance of this finding awaits future evaluation.