Die eosinophile Entzündung der Nasenschleimhaut

Zusammenfassung

Einleitung: Entzündliche Erkrankungen sind die häufigsten Erkrankungen und damit auch wesentlich bei den häufigsten Todesursachen beteiligt. Im HNO-Bereich stellen neben den viralen bakteriellen Entzündungen vor allem die eosinophilen Entzündungen der Atemwege ein Problem dar. Sie sind das wesentliche pathologische Substrat bei der allergischen Rhinitis, dem Asthma bronchiale, der Polyposis nasi, der chronischen Sinusitis und bei einer großen Zahl ungeklärter Rhinitiden wie der nichtallergischen eosinophilen Rhinitis. In der vorliegenden Übersicht werden die Grundlagen der eosinophilen Entzündung beschrieben.

Methoden und Ergebnisse: Die Zellen reifen im Knochenmark unter dem Einfluss von IL-5 und Eotaxin heran, werden durch deren Zytokinbefehle mobilisiert und mittels Adhäsion spezifisch ins Gewebe geschleust. Die Adhäsion findet unter dem Einfluss von VCAM-1 und anderen statt. Im Gewebe werden sie dann durch verschiedene Stimuli wie Immunglobulinrezeptoren und IL-5 aktiviert, setzen Mediatoren und Zytokine frei und bewirken weitere entzündliche Veränderungen. Die Folgen der Aktivierung mit ihren multiplen Mediatoren sind dann die klinischen Symptome im Organ und hier ist es vor allem die Spätphase der Typ-1-Reaktion und die weiter gehende entzündliche Infiltration. Die klinische Relevanz steigt noch durch die Interaktionen mit Viren und die Effekte auf muskarinerge Synapsen. Diagnostisch lässt sich die eosinophile Entzündung lokal mit der Messung von kationischen Proteinen durchführen.

Zusammenfassung: Somit sind auch die heutigen und zukünftige therapeutischen Ansätze von besonderer Relevanz. Die gängige Therapie besteht in der lokalen und auch systemischen Steroidgabe, positive Effekte lassen sich auch mit Antikörpern gegen Interleukin 5 und 4 erzielen, auch Anti-IgE scheint eine Wirkung zu zeigen.

Abstract

Introduction: Inflammatory diseases are very frequent and cause reasonable mortality. They are the major part in upper airway diseases in ENT. Eosinophil inflammation is a key feature in allergic rhinitis, asthma, nasal polyps and non-allergic rhinitis. The mechanism and the consequences of eosinophil inflammation are described in this review.

Methods and Results: Eosinophils mature in bone marrow, mainly under the influence of IL-5 and eotaxin. Once mobilised to circulation, they accumulate in inflammatory sites by specific adhesion. VCAM-1 and other adhesion molecules are involved in this process. In the tissue, eosinophils get activated by different stimuli like immunoglobulin receptors and cytokines like IL-5. Activated eosinophils release toxic proteins, mediators and cytokines and thus trigger further inflammatory response. This leads to the late phase reaction and continuing inflammatory reaction. Eosinophils also interact with virus infections and have effects on nerve endings with the M2 receptor.

Conclusions: Eosinophil inflammation may be monitored via the determination of cationic proteins in nasal secretions. Corticosteroids are very effective in the treatment of eosinophil inflammation, and anti-IL-5 and anti-IL-4 antibodies seem to be effective, too.

Schlüsselwörter

Allergie - Entzündung - Allergische Rhinitis - Eosinophile Granulozyten - IL-5

Key words

Nasal allergy - Eosinophil inflammation - Therapy - IL-5

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