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*Corresponding author: E-mail: drdjuraev@mail.ru; 
 
 
 

Asian Journal of Immunology 
 
3(1): 124-130, 2020; Article no.AJI.55718 
 

 
 

 

 

Results of Allergological and Immunological 
Research in Patients with Polipoid Rhinosinusitis 

 
J. A. Djuraev1*, U. S. Khasanov1, U. N. Vohidov2 and S. S. Sharipov2 

 
1
Tashkent Medical Academy,

 
Uzbekistan. 

2
Tashkent State Dental Institute,

 
Uzbekistan.

 

 
Authors’ contributions  

 
This work was carried out in collaboration among all authors. Authors JAD and USK designed the 

study, performed the statistical analysis, wrote the protocol and wrote the first draft of the manuscript. 
Author UNV managed the analyses of the study. Author SSS managed the literature searches.  

All authors read and approved the final manuscript. 
 

Article Information 
 

Editor(s): 
(1) Dr. Wagner Loyola, Brazilian Agricultural Research Corporation, Brazil. 

(2) Dr. Darko Nozic, University of Belgrade, Serbia. 
Reviewers: 

(1) Ekaterini Goudouris, Universidade Federal do Rio de Janeiro, Brazil. 
(2) Gilbert Batieka Bonsaana, University for Development Studies, Ghana. 

Complete Peer review History: http://www.sdiarticle4.com/review-history/55718 

 
 
 
 

Received 10 February 2020  
Accepted 16 April 2020 
Published 22 April 2020 

 
 

ABSTRACT 
 

An exceptional role in protecting against pathogenic effects of various pathogenic and opportunistic 
microorganisms is played by immunoglobulins of the main classes. As our studies showed, before 
treatment, the IgG content in patients did not differ significantly from the control. The average IgA 
level in patients of both groups before surgery was slightly reduced (P> 0.05). Given the important 
role of IgA in protecting the body and, above all, the mucous membranes from infection, it can be 
concluded that such a disturbance of the biosynthesis of this class of immunoglobulin may be one 
of the reasons for the decrease in immune reactivity and frequent infectious processes. A sharp 
increase in serum IgE levels (239 ± 19.1 IU/ml) was observed in patients with eosinophilic 
polyposis rhinosinusitis, which we associate with an increase in IL-4 content and increased 
allergization of the body. This relative difference between patients of the two groups proves the 
need for appropriate diagnosis and treatment of chronic polyposis of rhinosinusitis. The aim of our 
research work was study allergically and immunologically results in patients with 
polipoidrhinosinusitis. 
 

Original Research Article 



 
 
 
 

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125 

 

Keywords:  Nasal polyposis; osteomeatal complex; rhinosinusitis; nasal septum; allergen; immune 
system. 

 

1. INTRODUCTION 
 
The second half of the last century was marked 
by the transition of the center of gravity from 
otiatrics to rhinology. The reason for this is not 
only an increase in the load on the upper 
respiratory tract from the outside in the human 
environment, but also significant changes in the 
population, expressed in the accumulation of 
negative genetic deficiency and, above all, in the 
immune system. Particularly complex and 
unclear are the causes of nasal polyposis [1,2]. 
 
Today, many theories have been proposed for 
the etiology and pathogenesis of chronic 
polyposis rhinosinusitis (CID), unfortunately, 
many causative factors, as well as their 
relationship and role in the formation of nasal 
polyps, are not fully understood [3]. 
 
A number of theories of the etiology of nasal 
polyposis are known, and they are not mutually 
exclusive: bacterial and fungal infections, 
superantigenic stimulation of the immune 
system, the formation of biofilms, anatomical 
abnormalities of the osteomeatal complex, ciliary 
dysfunction, allergies, secondary immune-
deficiency [4]. 
 
In this regard, some foreign authors, according to 
which diseases accompanied by the formation of 
nasal polyps are divided into 5 groups. The first 
group consists of systemic genetically caused 
diseases in the form of Kartagener syndrome 
and cystic fibrosis, the second group is chronic 
polypous-purulent rhinosinusitis (neutrophilic 
polyps), the third group is a local pathology in the 
osteomeatal complex with impaired mucociliary 
clearance in the paranasal sinuses and the 
formation of a productive process in thechoanal 
polyps, the fourth group is a chronic infectious-
allergic rhinosinusitis with a final stage of 
development in the form of a chronic polypous 
allergy rhinosinusitis (eosinophilic polyps), the 
fifth group is the “asthmatic triad” as a pseudo-
allergic disease caused by a metabolic disorder 
of arachidonic acid: aspirin-induced nasal polyps 
[5,6]. 

 
S. V. Ryazantsev et al. (2006) consider nasal 
polyposis and SNPs as a multifactorial etiological 
syndrome that occurs in individuals predisposed 
to a specific tissue reaction. According to this 
theory, the formation of nasal polyps is 

associated with an innate predisposition and 
exposure to environmental factors, such as 
mechanical, physical, chemical, biological factors 
(viruses, bacteria, fungi, allergens). In this case, 
a disturbance of the reactivity of the 
parasympathetic nervous system, immunity, 
mucociliary transport, mucosal hypersensitivity, 
defects in membranes and DNA in the nuclei of 
cells areconsidered a congenital predisposition 
[7,8]. The combination of these two factors 
includes pathogenetic mechanisms, that is, they 
lead to a disturbance of neuro-trophic 
innervation, mast cell degranulation, the release 
of biologically active substances, which in turn 
increase vascular permeability, followed by 
tissue edema and the formation of polyps. 

 
According to another theory proposed by M. Yu. 
Korkmazov (2010), forpolypous sinusitis, 
microcirculation in the middle nasal passage 
changes in the form of vasomotor reactions, 
narrowing of the arterioles and a decrease in the 
number of functioning capillaries, which lead to 
the accumulation of metabolic products and 
retention of tissue fluid, which contributes to the 
development of edema [9,10]. 
 
N. N. Naumenko et al. (2005) suggest that 
forpolypousrhinosinusitis, a disturbance of the 
adaptive-trophic function of the autonomic 
nervous system is important, and contributes to 
the development of neurodystrophic changes in 
the nasal mucosa, leading to the formation of 
polyps. 

 
V. S. Piskunov (2006) believes that a disturbance 
of the aerodynamics of the nose during 
deformities of the nasal septum leads to a slowly 
developing inflammatory process of the nasal 
mucosa, which manifests itself as the formation 
of a polyp in the absence of pathological 
changes in the paranasal sinuses. 

 
In recent years, the role of metabolic disorders of 
arachidonic acid, which leads to "aspirin 
intolerance" [11,12], has been intensively studied 
in patients with CID. The classical clinical picture 
of the “aspirin” triad implies the presence of 
bronchial asthma in combination with 
eosinophilic rhinitis or CPRS, the manifestations 
of which sharply increase after taking non-
steroidal anti-inflammatory drugs (NSAIDs) [13]. 
In this regard, the importance of leukotrienes in 
the development of allergic inflammation is very 



 
 
 
 

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126 

 

significant. They increase vascular permeability, 
promote the mobilization and activation of pro-
inflammatory cells in the airways, participate in 
the release of other pro-inflammatory agents, 
increase the secretory activity of the glands, can 
enhance the action of other allergy mediators, for 
example, histamine [14] and as a result "aspirin-
induced" polyps [15] develop. 
 
In addition, recently, many authors have been 
paying attention to the role of toll-NOD- receptors 
in the occurrence of nasal polyps and the genetic 
aspects of the development of CPRS [16,17]. 
Unfortunately, the results of these studies have 
not yet led to a complete disclosure of the 
pathogenesis of the polyposis process. 
 
Thus, chronic polypousrhinosinusitis should be 
considered amultiple etiologies disease, in the 
development of which the influence of infectious 
factors and allergens plays the main role, which 
leads to the development of a chronic 
inflammatory process and allergization of the 
body, which affect different body systems, which 
aggravates the main pathology and leads to a 
decrease in the quality ofpatient’s life, therefore 
this problem is urgent, and needs a solution 
which is urgent. 
 

2. MATERIALS AND METHODS 

 
In accordance with the purpose of the study and 
to achieve its objectives, clinical studies were 
conducted in 150 patients with chronic kidney 
disease who were examined and treated in the 
ENT department of the 3rd clinic of the Tashkent 
Medical Academy in 2018-2019. 
 

All patients with chronic kidney disease 
underwent specific allergological examination, 
which included collecting an allergic history and 
staging skin tests with allergens. Allergological 
examination was carried out according to a 
special scheme developed by the Allergy 
Research Laboratory of the 2

nd
 clinic of the 

Tashkent Medical Academy. 
 

3. RESULTS AND DISCUSSION 
 
For skin tests, allergens from timothy grass 
pollen, team hedgehog, fescue, ryegrass, 
bonfire, birch, wormwood, ragweed, corn, 
sunflower, ash, walnut, oak and dandelion were 
used (Table 1). 
 
Table 1 shows that the reaction to each allergen 
was different. So, in 92 patients there was a 
positive reaction of varying degrees to histamine. 
However, no reaction was observed on fescue, 
ragweed, and hedgehog. In addition, a negative 
reaction to an allergen was recorded in 58 
patients. 
 
In 92 patients, a scarification test gave a positive 
result. This indicates the undoubted participation 
of the allergic factor in the development of 
polypousrhinosinusitis. These data correlated 
with blood test results. So, in a blood test in 92 
(33.3%) patients, eosinophilia was noted. 
 

Peripheral blood eosinophils were determined in 
a general blood test in all patients. In 92 patients 
with chronic polypousrhinosinusitis, the number 
of eosinophils was increased. In particular, 
eosinophilia was observed in 88 examined with a  

Table 1. Allergy data in patients with CRS 

 

Pollenallergen Patients with CRS (n=150) Results 

+ ++ +++ 

Dandelion 18 2 2 14 

Fescue - - - - 

Sunflower 16 - 3 13 

Sagebrush 6 - 4 2 

Ash 8 2 2 4 

Bonfire 10 2 2 6 

Birch 2 1 1 - 

Ragweed - - - - 

Corn 9 - 3 6 

Oak 8 4 4  

Cocksfoot - - - - 

Histamine 92 38 25 29 

Neg. 58 - - - 



 
 
 
 

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127 

 

positive result for the allergen, however, in the 
remaining 62 patients the number of eosinophils 
remained within the normal range (Table 2). 
 

Peripheral blood eosinophilia indicates the 
continued role of allergies in the development of 
CRS. Allergic background was found in 58.67% 
of the examined patients. 
 

Based on the results of the study, it should be 
noted that the presence of a positive allergic 
reaction in patients with eosinophilia suggests 
the appointment of topical CS for the purpose of 
pathogenetic treatment, as well as 2-3 
generation antihistamines for the symptomatic 
treatment and removal of symptoms of the 
disease. 
 

Studies of the immune status in CRS patients 
were carried out in the laboratory of 
immunocytokines of the Institute of Immunology 
of the Academy of Sciences of the Republic of 
Uzbekistan (head of laboratory, MD Ismailova 
A.A.). The determination of cellular, humoral 
immunity units was carried out using monoclonal 
antibodies by the method of indirect rosette 
formation, to determine the cytokines used test 
systems produced by Vector-Best of the Russian 
Federation, based on the sandwich method of 
enzyme-linked immunosorbent assay using 
horseradish peroxidase as an indicator enzyme. 
The results will be analyzed in the following sub-
chapters. 
 

Given the important pathogenetic role of immune 
system disorders in the mechanisms of CRS 
development, as well as unsatisfactory treatment 
results, allergization of the body, and the 
possibility of developing toxic and side effects, 
we studied the immune status of patients. 
 

An immunological study of cellular and humoral 
immunity was performed in 79 (52.7%) patients 
who were hospitalized in the ENT department of 
the 3rd clinic of the Tashkent Medical Academy 
in 2012-2013. (Table 2). 
 

As can be seen from Table 3, in patients there 
was a significant decrease in the content of T-
lymphocytes (CD3 cells), which averaged 47.56 

± 6.57 and 46.84 ± 4.52, significantly differing 
from the control data (p <0, 05). The absolute 
value of CD3 cells was also below normal. 

 
The level of immunoregulatory subpopulations of 
T-lymphocytes of T-helper cells (T4) and T-
suppressors/cytotoxic cells (T8) was lower than 
the control values. For T-helpers, the CD4 cell 
count averaged 26.96 ± 2.58 and 26.19 ± 2.18, 
which was significantly lower than the control (p 
<0.05). In addition, there was a significant 
decrease in the number of T-helpers (P <0.05). 

 
Both the absolute and relative contents of T-
suppressors - cytotoxic cells (CD8) were also 
significantly lower than the control (P <0.05). 

 
An equivalent decrease in the number of both T-
helpers and T-suppressors caused significant 
changes in the immunoregulatory index. The 
ratio of CD4/CD8 lymphocytes was below the 
control. These data indicate impaired immunity 
as a result of a prolonged inflammatory process 
that caused secondary immunodeficiency in the 
body of patients with various forms of chronic 
polypousrhinosinusitis. 

 
Thus, in patients with CRS, there were significant 
disturbances of the T-cell immunity indices, 
which is typical for chronic respiratory diseases. 
Indicators of the humoral immunity are presented 
in Table 4. 

 
An exceptional role in protecting against 
pathogenic effects of various pathogenic and 
opportunistic microorganisms is played by 
immunoglobulins of the main classes. As our 
studies showed, before treatment, the IgG 
content in patients did not differ significantly from 
the control. The average IgA level in patients of 
both groups before surgery was slightly reduced 
(P> 0.05). Given the important role of IgA in 
protecting the body and, above all, the mucous 
membranes from infection, it can be concluded 
that such a disturbance of the biosynthesis of this 
class of immunoglobulin may be one of the 
reasons for the decrease in immune reactivity 
and frequent infectious processes. 

 
Table 2. The content of eosinophils in peripheral blood in patients with CRS  

 
Eosinophils in the 
peripheral blood 

Patients with EPRS, 
(n=90),% 

Patients with 
NPRS, (n=60),% 

Control group, 
(n=20),% 

6,7±1,51* 2,1±1,09 2,2±1,07 
Note:* - Differences regarding the group up to 5 years are significant (* - P<0,05) 

 



 
 
 
 

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128 

 

Table 3. Indicators of cellular immunity in patients with CRS 

 
Indicator Patients with EPRS, 

(n = 48) 
Patients with NPRS, 
(n=31) 

Control group, 
(n=20) 

Whitebloodcells, μl 6187,5±943,88 6035,5±1759,84 6295,0±737,33 
Lymphocytes, % 30,7±9,33 29,7±4,19 29,4±4,15 
Lymphocytes, μl 1717,0±440,38 1790,3±328,99 1945,0±225,89 
CD3+, % 47,2±6,05 47,2±5,24 57,9±4,26 
CD3+, μl 814,2±281,30 758,8±135,84 1009,1±214,33 
CD4+, % 26,9±2,43** 26,5±2,28** 36,4±1,90 
CD4+, μl 466,4±140,06* 443,0±92,37*** 856,7±71,23 
CD8+, % 19,6±4,60 20,4±3,30 22,6±1,90 
CD8+, μl 330,4±125,28 339,4±45,45* 498,4±60,84 
IRI 1,44±0,21 1,3±0,13** 1,75±0,10 
CD16+, % 19,7±3,60 16,1±4,89 14,2±1,84 
CD20+, % 22,3±2,00 21,6±2,71 21,9±2,02 
CD20+, μl 383,7±121,50 366,0±91,66 412,4±95,94 
CD23+, % 24,2±2,25 19,8±1,47 20,0±1,34 
CD38+, % 31,6±7,02 31,4±6,80 20,9±5,35 
CD95+, % 24,0±3,15 19,7±1,55 19,8±1,51 

Note: * - Differences relative to control group data are significant (*** - P<0,001) 
 

Table 4. Indicators of cellular immunity in patients with CRS 
 

Indicator Patients with EPRS, 
(n=48) 

Patients with NPRS, 
(n=31) 

Control group, 
(n=20) 

IgG, mg% 1144,2±168,93 1184,3±99,74 1176,2±99,17 
IgA, mg% 141,9±14,15 167,8±17,88*** 128,4±16,94 
IgM, mg% 118,3±18,22 120,3±15,22 121,7±15,16 
CIC large, cu 17,8±6,03 19,8±5,09 11,8±3,14 
CIC small, cu 28,1±9,17*** 22,3±8,80 21,8±6,92 

 Note: * - Differences relative to control group data are significant (*** - P<0,001) 

 
The IgM content showed a tendency to increase, 
but both the average values and its individual 
values did not differ significantly from the norm. 
 

The disturbances identified by us were 
manifested: 
 

- disturbance of the cellular component of 
immunity with insufficiency of 
immunoregulatory subpopulations of T-
helpers and T-suppressors (CD4 and CD8 
cells); 

 

-  inhibition of humoral immunity (IgA); 
 

- a decrease in natural cytotoxicity (CD16 
cells). 

 

This allows us to consider patients with CRS as 
patients with prevailing secondary 
immunodeficiency, which requires appropriate 
treatment using immunomodulators. 
 
An immunological study of cytokines and total 
IgE in serum was carried out in 79 (52.7%) 

patients who were hospitalized in the ENT 
department of the 3

rd
 clinic of the Tashkent 

Medical Academy in 2012-2013 (Table 5). 
 
As our study showed, elevated levels of IL-2 in 
serum were observed in patients of both groups, 
but especially in patients with chronic 
"neutrophilic" polypousrhinosinusitis. Such an 
increase in the level of cytokine indicates a 
disturbance of the immune state of the body, 
since IL-2 is responsible for the immune 
response. 
 
At the same time, the content of IL-4, which is 
responsible for the allergization of the body, was 
also increased in patients of both groups, but 
more in patients with eosinophilic poly-
pousrhinosinusitis. 
 
The content of IL-8 increased (9.9 ± 3.72 pg/ml) 
in patients with “neutrophilic” polyposis 
rhinosinusitis, remaining within the normal range 
in patients with “eosinophilic” polyposis 
rhinosinusitis. 



 
 
 
 

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129 

 

Table 5. The content of cytokines and their ratio with total IgE in serum in patients with CRS 
 

Indicator Patients with EPRS, 
(n=48) 

Patients with NPRS, 
(n=31) 

Control 
group, (n=20) 

2-2, pg / ml 10,6±3,53 12,5±4,81 5,5±0,44 
2-4, pg / ml 6,4±2,31 7,3±1,13 4,7±1,15 
2-8, pg / ml 8,3±4,58 9,9±3,72 5,7±0,84 
IgE,IU / ml 239±19,1*** 43,0±30,26 14,6±8,57 

Note: * - Differences relative to control group data are significant (* - P<0,05, ** - P<0,01, *** - P<0,001) 
 

A sharp increase in serum IgE levels (239 ± 19.1 
IU/ml) was observed in patients with eosinophilic 
polyposis rhinosinusitis, which we associate with 
an increase in IL-4 content and increased 
allergization of the body. This relative difference 
between patients in the two groups proves the 
need for appropriate diagnosis and treatment of 
CRS. 
 

4. CONCLUSIONS 
 

Thus, we did not find a clear deficit in the content 
of IgG and IgM. Only an increase in the level of 
IgA was observed, indicating the activation of the 
body's immune systems, which can serve as a 
factor in the development of a long inflammatory 
process, and in the subsequent relapse of the 
disease. Our data confirmed that multistep 
surgical intervention and inadequate 
conservative treatment adversely affect the 
immunological reactivity of CRS patients. In 
these patients, disturbances of immune 
homeostasis and a deficiency of cellular and 
humoral immunity are detected. A study of 
cellular and humoral immunity revealed that 
“eosinophilic” polyposis rhinosinusitis is 
characterized by an increase in the number of 
natural killers, allergization factor and apoptosis, 
IL-2, IL-4 and IgE, while “neutrophilic” polyposis 
rhinosinusitis indicates a significant increase in 
IgA and IL- 8, which indicates the presence of a 
long-lasting chronic inflammatory process. 
 

CONSENT 
  

As per international standard informed and  
written participant consent has been collected 
and preserved by the authors. 
  

ETHICAL APPROVAL         
  

As per international standard written ethical 
permission has been collected and preserved by 
the author(s). 
 

COMPETING INTERESTS 
 

Authors have declared that no competing 
interests exist. 
 

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