Demonstration of RANTES and eosinophilic cataionic protein in otitis media with effusion with allergy
Introduction
Otitis media with effusion (OME) is defined as an inflammation of the middle ear accompanied by fluid collection in the middle ear cleft without signs and symptoms of acute infection. The allergic response may, at least, predispose the patient to middle ear effusion (MEE) by congesting and obstructing the Eustachian tube. There are some studies of a role for allergy in OME etiology [1], [2], [3], [4]. Recently, Wright et al. [5] have demonstrated elevated levels of eosinophil cationic protein (ECP) in both MEEs of patients with OME and middle ear mucosal biopsy specimens from these patients. And Nagamine et al. [6] observed the accumulation of eosinophils in MEE, middle ear mucosa and nasal polyps, and the eosinophils were highly activated with degranulation. High level of ECP was also recovered from MEE.
Regulated upon activation, normal T cell-expressed and -secreted (RANTES) is a chemokine which is an effective eosinophil and memory T cell chemoattractant and activator, and eosinophil is an important effector cell in allergic disease. The purpose of this study was to determine whether RANTES is increased in the effusions of OME with allergy. We also evaluated the correlation between RANTES and ECP to determine the role of RANTES as an eosinophil activator in the pathogenesis in OME with allergy.
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Patients
The MEE samples were collected from 25 patients with allergy and 20 patients without allergy. The patients aged 5–11 years (mean 6) were selected for myringotomy with ventilation tube insertion based on standard criteria including persistent MEE for 3 months. Patients were excluded if they had a history of acute otitis media in the preceding 3 months or a history of multiple placements of tympanostomy tubes. None had immunodeficiency or congenital malformations. All had documented mild to
Results
RANTES in MEE was significantly higher in OME with allergy than OME without allergy (0.99±0.14 vs. 0.34±0.03 ng/ml; P<0.01, Table 1). The level of ECP in MEE was significantly higher in OME with allergy than OME without allergy (24.1±4.5 vs. 8.91±3.5 μg/ml; P<0.05, Table 1). The concentrations of RANTES were positively correlated with ECP concentrations in the MEE of OME with allergy (r=0.63, P<0.01).
Discussion
In this study, we measured RANTES and ECP levels in the MEE. RANTES is an 8 kDa chemokine which is considered to be involved in the pathophysiology of allergic inflammation because of their ability to drive eosinophils through their binding sites, chemokine receptors, expressed on eosinophils [7], [8]. Recently, Schousboe et al. [9] measured the amount of RANTES in MEE with respect to monocyte-chemotactic properties and found that RANTES might explain the recruitment of monocytes in OME.
Acknowledgements
This work was supported by grant No. (R05-2001-000-00395-0) from the Basic Research Program of the Korea Science and Engineering Foundation.
References (13)
- et al.
Increased expression of major basic protein (MBP) and interleukin-5 in middle ear biopsy specimens from atopic patients with persistent otitis media with effusion
Otolaryngol. Head Neck Surg.
(2000) - et al.
Clinical characteristics of so called eosinophilic otitis media
Auris Nasus Larynx
(2002) - et al.
Allergy increases susceptibility to otitis media with effusion in a rat model
Otolaryngol. Head Neck Surg.
(1999) Is serous otitis media due to allergy or infection?
Ann. Allergy
(1958)- G.J. Shambaugh, Pathology and clinical course of inflammatory diseases of the middle ear, in: G.J. Shambaugh (Ed.)...
Allergy management of refractory otitis media
Otolaryngol. Head Neck Surg.
(1990)
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