%0 Journal Article %A Yoshihiro Kanemitsu %A Kensuke Fukumitsu %A Ryota Kurokawa %A Norihisa Takeda %A Yoshiyuki Ozawa %A Ayako Masaki %A Junya Ono %A Kenji Izuhara %A Jennifer Maries Yap %A Hirono Nishiyama %A Satoshi Fukuda %A Takehiro Uemura %A Tomoko Tajiri %A Hirotsugu Ohkubo %A Ken Maeno %A Yutaka Ito %A Tetsuya Oguri %A Masaya Takemura %A Motohiko Suzuki %A Akio Niimi %T Moulds and Staphylococcus aureus enterotoxins are relevant allergens to affect type2 inflammation and clinical outcomes in CRS patients %D 2020 %R 10.1183/23120541.00265-2020 %J ERJ Open Research %P 00265-2020 %X Background Sensitisation to moulds and Staphylococcus aureus enterotoxins (SEs) is associated with the pathophysiology of both asthma and chronic rhinosinusitis (CRS). The purpose of this study was to clarify the contribution of these allergens sensitisation on type2 inflammation in blood, nose, and lower airways, and clinical outcomes in CRS patients.Methods We prospectively enrolled 56 CRS patients who underwent endoscopic sinus surgery (ESS) (20 with comorbid asthma), and 28 healthy controls between October 2015 and December 2017. CRS patients were followed 12 months after surgery. Type2 inflammation-related biomarkers were analysed using blood, resected tissue samples, and sputum. Ten allergens including Alternaria, Aspergillus, and SEs were measured. Type2 inflammation-related biomarkers and clinical outcomes were compared in the stratification with the presence or absence of allergen sensitisation.Results Sensitisation rate to moulds and SEs in asthmatic patients was increased when changing the cut-off value of specific IgE titer from 0.35 UA·mL−1 to 0.10 UA·mL−1 (1.7 and 4.5 folds, respectively). Moulds and SEs affected the prevalence of asthma and eosinophilic CRS by interacting with each other. All type2-related biomarkers but eosinophils in sinus tissue were significantly higher in patients with moulds or SEs (moulds/SEs) sensitisation (≥0.10 UA·mL−1) (n=19) than in those without (n=37) and healthy subjects (all p<0.05). Meanwhile, moulds/SEs sensitisation did not affect longitudinal changes in clinical outcomes after ESS. Changes in serum moulds/SEs-IgE levels by ESS remained unclear.Conclusion Moulds/SEs sensitisation (≥0.10 UA·mL−1) may affect the development of type2 inflammation and clinical outcomes in CRS patients.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Yoshihiro Kanemitsu reports research grants from Novartis Pharma, and Tanabe Mitsubishi pharma for the submitted work, and grants from MSD and Kyowa-Kirin corporations outside the submitted work.Conflict of interest: Dr. Fukumitsu has received a grant from Novartis for 500000 JPY and GSK for 2000000 JPY outside the submitted work.Conflict of interest: Dr Kurokawa has nothing to disclose.Conflict of interest: Dr. Takeda has nothing to disclose.Conflict of interest: Dr. Ozawa has nothing to disclose.Conflict of interest: Dr. Masaki has nothing to disclose.Conflict of interest: Mr. Ono is a employee of Shino-test corporation.Conflict of interest: Professor Izuhara reports research grants from Shino-Test Corporation for the submitted work.Conflict of interest: Ms Yap has nothing to disclose.Conflict of interest: Dr. Nishiyama has nothing to disclose.Conflict of interest: S. Fukuda reports speaker honoraria from AstraZeneca and Eli Lilly Japan outside the submitted work.Conflict of interest: Dr. Uemura has nothing to disclose.Conflict of interest: Dr. Tajiri has nothing to disclose.Conflict of interest: Dr Ohkubo has received a research grant from Boehringer Ingelheim outside the submitted work.Conflict of interest: K. Maeno reports speaker honoraria from Pfizer and Chugai Pharmaceutical outside the submitted work.Conflict of interest: Dr. Ito has nothing to disclose.Conflict of interest: Dr Oguri has received a research grant from Ono outside the submitted work.Conflict of interest: Dr Takemura has received a research grant from Pfizer outside the submitted work.Conflict of interest: Dr Suzuki reports a research grant from Kobayashi Foundation for the submitted work.Conflict of interest: Dr. Niimi reports personal fees from Astellas, AstraZeneca, Kyorin, GSK, MSD, Shionogi and Boehringer Ingelheim, and grants from Astellas outside the submitted work. %U https://openres.ersjournals.com/content/erjor/early/2020/09/10/23120541.00265-2020.full.pdf