SAN DIEGO – Women with chronic rhinosinusitis and co-occurring nasal polyps appear to harbor more severe disease, compared with men, results from a large retrospective study demonstrate.
"For now, these are very preliminary studies, so there is not a lot of clinical application," Kathryn E. Hulse, Ph.D., said in an interview before the annual meeting of the American Academy of Allergy, Asthma, and Immunology, where the work was presented. "The hope is that if we can figure out why chronic rhinosinusitis with nasal polyps is more severe in women, we would be able to design better therapeutic strategies to treat this disease in both men and women."
Up to half of patients with chronic rhinosinusitis have comorbid asthma, and Dr. Hulse and her associates at Northwestern University, Chicago, have previously reported that a subset of chronic rhinosinusitis patients with nasal polyps (CRSwNP) have elevated autoantigen-specific antibodies within their nasal polyps (J. Allergy Clin. Immunol. 2011;128:1198-206). In what she said is the first study of its kind, Dr. Hulse of the school’s division of allergy and immunology, and her associates retrospectively reviewed a database of 1,240 patients who underwent nasal surgery or were treated for CRS at Northwestern. They evaluated the effect of gender on the prevalence of CRSwNP, aspirin sensitivity, and asthma status, and used enzyme-linked immunosorbent assay to compare levels of eosinophil cationic protein and anti-dsDNA antibodies in NP extracts from men and women.
Kathryn Hulse, Ph.D.
Mean patient age was 41 years, and 48% were women. Although women comprised about 50% of controls and CRS patients without NP, a significantly smaller proportion of CRSwNP patients were female (35%). Women with CRSwNP were significantly more likely to have comorbid asthma, and 65% of patients with aspirin-exacerbated respiratory disease (CRSwNP plus asthma and aspirin sensitivity) were women. Asthmatic women with CRSwNP had the highest levels of autoantigen-specific IgG and eosinophil cationic protein, and were significantly more likely to have revision surgeries.
"We thought we would find that CRSwNP was more prevalent and severe in women, especially because these patients have asthma and some features of local autoimmunity, which can be more prevalent and severe in women," Dr. Hulse said. "Instead, we found that men were more likely to have CRSwNP than women, but women did seem to have more severe disease."
She acknowledged certain limitations of the study, including the fact that it focused solely on patients receiving care at a tertiary care center, "so we do not know if these results would be similar if we looked at the general population of people with CRSwNP who do not seek out specialized care. Also, these data were collected for patients at only one location, so we also do not know if the results would be similar at other tertiary care centers."
During a press briefing at the meeting, Dr. Hulse characterized the findings as "an important first step in identifying a potential area of future research and providing the justification for doing larger studies to see if this holds true in a larger population [of patients] or at other sites."
The study was funded by grants from the National Institutes of Health, including the Building Interdisciplinary Research Careers in Women’s Health program. Dr. Hulse said that she had no relevant financial conflicts.