TY - JOUR T1 - Moulds and <em>Staphylococcus aureus</em> enterotoxins are relevant allergens to affect Type 2 inflammation and clinical outcomes in chronic rhinosinusitis patients JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00265-2020 VL - 6 IS - 4 SP - 00265-2020 AU - Yoshihiro Kanemitsu AU - Kensuke Fukumitsu AU - Ryota Kurokawa AU - Norihisa Takeda AU - Yoshiyuki Ozawa AU - Ayako Masaki AU - Junya Ono AU - Kenji Izuhara AU - Jennifer Maries Yap AU - Hirono Nishiyama AU - Satoshi Fukuda AU - Takehiro Uemura AU - Tomoko Tajiri AU - Hirotsugu Ohkubo AU - Ken Maeno AU - Yutaka Ito AU - Tetsuya Oguri AU - Masaya Takemura AU - Motohiko Suzuki AU - Akio Niimi Y1 - 2020/10/01 UR - http://openres.ersjournals.com/content/6/4/00265-2020.abstract N2 - 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 sensitisation to these allergens to Type 2 inflammation in the blood, nose and the 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 up for 12 months after surgery. Type 2 inflammation-related biomarkers were analysed using blood, resected tissue samples and sputum. 10 allergens including Alternaria, Aspergillus and SEs were measured. Type 2 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 titre from 0.35 UA·mL−1 to 0.10 UA·mL−1 (1.7- and 4.5-fold, respectively). Moulds and SEs affected the prevalence of asthma and eosinophilic CRS by interacting with each other. All Type 2 inflammation-related biomarkers except for eosinophils in sinus tissue were significantly higher in patients with mould or SE (mould/SE) sensitisation (≥0.10 UA·mL−1) (n=19) than in those without (n=37) and healthy subjects (all p&lt;0.05). Meanwhile, mould/SE sensitisation did not affect longitudinal changes in clinical outcomes after ESS. Changes in serum mould/SE-IgE levels after ESS remained unclear.Conclusion Mould/SE sensitisation (≥0.10 UA·mL−1) may affect the development of Type 2 inflammation and clinical outcomes in CRS patients.Alternaria, Aspergillus and S. aureus enterotoxins are important allergens affecting Type 2 inflammation and clinical outcomes in CRS patients. Sensitisation to moulds/SEs (≥0.10 UA·mL−1) would be meaningful in the pathophysiology of CRS. https://bit.ly/3bUG8ZT ER -