AB54 Abstracts J ALLERGY CLIN IMMUNOL

FEBRUARY 2015
SATURDAY

171 The Roles of Type 2 Innate Lymphoid Cells (ILC2) in Chronic

Rhinosinusitis (CRS)
Keisuke Uno1, Yoshinori Matsuwaki, MD, PhD1, Kazuhiro Omura1, Eika
Hayashi1, Hirohito Kita, MD2, Nobuyoshi Otori, MD1, Hiromi Kojima,
MD1; 1Department of Otorhinolaryngology, The Jikei University School
of Medicine, Tokyo, Japan, 2Departments of Immunology and Internal
Medicine, Mayo Clinic, Rochester, MN.
RATIONALE: Chronic rhinosinusitis (CRS) is one of the most frequent
chronic diseases, and little is understood about its pathogenesis.
Eosinophils are considered to play a major role in its pathology, but we
still know little which is causing chronic immune activation and persistent
eosinophilic inflammation in CRS. Recently, type 2 innate lymphoid cells
(ILC2s, lineage (-), CD45 (+), CD127 (+), CD294 (+)) were identified as a
candidate, which produce highly levels of Th2 cytokines such as IL-5 and
IL-13, which activates eosinophils. We hypothesized that ILC2s are
enriched in blood and nasal polyps in patients with eosinophilic CRS
(ECRS) and are associated with its pathology.
METHODS: The patients with CRS or pituitary adenoma (normal sinus)
who underwent endoscopic sinus surgery (ESS) in Jikei University
Hospital were enrolled. We used PBMC and nasal polyps (NPs) from
patients with CRS or normal subjects, and analyzed the amount of ILC2 by
flow cytometry. We also investigated the distribution of ILC2s in NPs by
immunohistochemistry. EDN and cytokines in NPs were measured by
ELISA.
RESULTS: EDN and Th2 cytokines are significantly higher in ECRS than
non-eosinophilic CRS (NECRS). The counts of ILC2s were significantly
higher in ECRS than NECRS. Immunostained ILC2 were showed in nasal
polyps of ECRS, but not in NECRS or normal subjects. The distribution of
ILC2 in NPs was observed as chain-like. ILC2’s CD25 surface expression
in PBMC was significantly higher in ECRS than NECRS.
CONCLUSIONS: ILC2 are considered as candidate of the commander in
ECRS, which strongly induce Th2 inflammation.
Enterobacter aerogenes, Klebsiella pneumoniae, and Haemophilus influen-
zae (4%).
CONCLUSIONS: Mupirocin therapy may alter sinus flora, resulting in
infection with unusual and resistant pathogens. The impact of topical
antibiotic therapy should be taken into account when treating patients with
CRS post-FESS.
173 Pediatric Nasal Polyp : How Do They Manifest and Respond
to Endoscopic Sinus Surgery
Young Min Ahn, MD; Department of Pediatrics, South Korea.
RATIONALE: Chronic rhinosinusitis with polyp in pediatric population
is an uncommon pathology and continues to be a challenging problem. In
children inflammatory polyp associated with frequent infection is more
common than eosinophilic polyp. This study aims to assess the clinical
features and surgical outcome of endoscopic sinus surgery (ESS) in
pediatric nasal polyp.
METHODS: Thirty patients younger than 18 years who had ESS for nasal
polyp from 2008 to 2013 were available for analysis by medical records.
We collected demographic and clinical data including age, sex, Lund-
Mackay score of CT, surgery procedure, recurrence and comorbidities
including asthma, allergy.Postoperative follow-up period ranged between
6 and 24 months.
RESULTS: There were 23 cases of chronic rhinosinusitis with nasal
polyposis (CRSNP) and 7cases of antrochoanal polyps (ACP). The mean
age of patients were 15 years with an age range of 6 to 18 years with 22
boys and 8 girls. 24 patients (80%) had bilateral disease. Twenty six
patients were treated with ESS and four patients with ESS with
concomitant adenoidectomy. Four patients (13.3%) showed recurrence
after ESS . CRSNP groups (13.0%) and ACP(14.3%) groups had no
significant difference in recurrence rate. CRSNP group showed higher CT
Lund-Mackay scores than ACP group. Four patients have allergy and two
patients have asthma.
CONCLUSIONS: Nasal polyps in children are more common in

172 Changes in Sinus Bacterial Culture Following Mupirocin

Treatment in Surgically Recalcitrant Chronic Rhinosinusitis
Jennifer L. Hill, MD1, Alexander G. Chiu, MD2, Tara F. Carr, MD3,4;
teenagers, are usually bilateral, and had good surgical outcome by ESS.
The results of this study suggest that pediatric ESS is a safe and efficacious
therapy for management of chronic rhinosinusitis with polyp in children
1
University of Arizona Department of Internal Medicine, Tucson, AZ, with low recurrence rate.
2
University of Arizona, Department of Otolaryngology, Tucson, AZ, 3Ari-
zona Respiratory Center, University of Arizona, Tucson, AZ, 4University
of Arizona Medical Center, Division of Pulmonary, Allergy, Critical Care
and Sleep Medicine, Tucson, AZ.
RATIONALE: Mupirocin sinonasal irrigations are commonly prescribed
for chronic rhinosinusitis (CRS) after functional endoscopic sinus surgery
(FESS). Data suggests that systemic antibiotics lead to alteration of the
innate sinus microbial community, contributing to refractory disease;
however, a paucity of data exists addressing the effect of topical antibiotics.
We sought to evaluate patterns of sinus microbial colonization in CRS
patients treated with mupirocin sinus irrigations after FESS.
METHODS: A retrospective chart review was conducted for consecutive
post-FESS CRS patients treated with mupirocin sinus irrigations on whom
sinus aspirate cultures were performed pre- and post mupirocin therapy.
Patients with immunodeficiency and those treated with oral antibiotics in
the six weeks prior were excluded from the study.
RESULTS: Twenty-two patients were identified, with mean age of 66
years, and average number of endoscopic sinus surgeries 1.9. Endoscopic
evidence of infection was present in 81.8% of cases. The most common
isolates prior to mupirocin were coagulase-negative staphylococci (31%)
and mixed respiratory flora (31%), followed by Staphylococcus aureus
(13%), Pseudomonas aeruginosa (9%), Propionibacterium acnes,
Streptococcus pneumoniae, and Klebsiella pneumoniae (4%). Following
mupirocin therapy (mean duration 5.1 weeks), the isolates were as follows:
Corynebacterium (27%), Pseudomonas aeruginosa (18%), Staphylococcus
aureus (13%), Achromobacter xylosoxidans (9%), Stenotrophomonas
maltophilia (9%), Eikenella corrodens, Acinetobacter baumannii,