Tsaryk V. Pathogenetic substantiation of treatment of chronic rhinosinusitis associated with deficiency of immunoglobulin E

The study involved 82 patients aged 18 to 61, with refractory course of chronic rhinosinusitis and verified immunoglobulin E deficiency (<10 IU/mL). There was held a retrospective screening of 4,476 patients. IgE-deficiency was detected in 7.6%, while the total deficiency (<5 IU/ml) was confirmed in 2.9% of patients. In 47% of cases among infections pathogens was found bacterial flora combined with excessive growth (> 106 CFU). In 37% of patients was revealed active forms of herpes viruses infections (HHV-6 and EBV), which often was associated with cervical lymphadenopathy and chronic fatigue syndrome. Serum levels of total IgG in patients with chronic rhinosinusitis were 10,85 ± 0,59 g/L, IgA - 1.3 ± 0.29 g/L, IgM - 1.21 ± 0.07 g/L. Generally was noted a reduce concerntration of total serum IgA (1,31 ± 0,29 g/L) compared with the control group (2,4 ± 0,22 g/L), p<0.05. Serum levels of IgG1 were significantly lower 5,09 ± 0,24 g/ L compared with the control group - 6,09 ± 0,15 g/L (p<0,05). In 20 patients (24.4%) with refractory course of chronic rhinosinusitis IgE-deficiency was combined with a decrease of serum IgA, IgG1, IgG2 and IgG3 concentrations, but no diagnostic signs of a deep deficiency. Based on the data we selected the first clinical diagnostic criteria for an isolated deficiency of immunoglobulin E, and found low levels of total serum IgA and subclasses IgG1, IgG2. Was approved the scheme of immunotherapy using donor immunoglobulin preparations for intramuscular and intravenous using, through which could significantly reduce the duration, frequency and severity of exacerbations of chronic rhinosinusitis in 87% of patients. Also significantly increased not only serum IgE concentrations (from 3,05 ± 1,21 to 12,5 ± 1,86 IU/ ml in the total deficit), but significantly increased serum concentrations of total IgG and subclasses IgG1, IgG2 (time of observation 6 months).