It is known that allergy is concerned in the origin of chronic sinusitis. In this report, localization of immunoglobulins and the distribution of immunoglobulin producing cells in the sinus mucosa of chronic maxillary sinusitis were studied with direct fluorescent antibody technique. Furthermore, lymphocytes in the sinus mucosa and peripheral blood were analyzed for T cell and B cell, and how allergic mechanisms are concerned in the chronicity of sinusitis wes studied from a view point of the relationship between cellular and humoral immunity.
Specimens were collected from 76 patients with chronic maxillary sinusitis at the time of operation, and frozen sections were prepared. Localization of immunoglobulins (IgG, IgA, and IgM) in the mucosa was observed with direct fluorescent antibody technique, and the numbers of immunoglobulin containing cells were counted. After fluorescent microscopic observation, the same specimen was stained with hematoxylineosin and methylgreen-pyronine and the cells were identified morphologically.
Classification and counting of T cells and B cells were made with E-rosette and EAC-rosette technique respectively in the sinus mucosa and in the peripheral blood of the patients normal subjects.
Results:(1) In the mucosa, IgG and IgM were localized in the epithelial layer and subepithelial interstitium. IgA was localized in the mucous layer and the subepithelial interstisium and also in the mucous gland.
(2) The number of the cells which contain each immunoglobulin was in the following order, IgG>IgA>IgM. Most of the cells were morphologically plasma cells, with also a few lymphocytes.
(3) The percentages of the T cells and B cells in the sinus mucosa were 34.8±12.9% and 47.5±15.1%, respectively ; and in the peripheral blood 42.1±15.9% and 43.6±14.7, respectively. In the peripheral blood of the normal subjects, the percentages of the T cells and B cells were 63.1±6.2% and 35.2±8.4, respectively.
(4) Comparing the numbers of T and B cells in the peripheral blood of the normal subjects with those of the patients, T cells were decreased and B cells were increased in the blood of the patients.
(5) As f or the histological findings of the mucosa and the percentages of T and B cells, there were more B cells in the infiltrating type, and more T cells in the fibrous type. Definite tendency was not seen in the edematous type.
Conclusion: From the above results, it is considered that humoral protective function in the maxillary mucosa is mainly performed by GgG and IgA. On the allergic mechanisms, the type III allergic reaction of Gell & Coombs seems to be more concerned with the infiltrating phases and to some extent to the edematous phase. It is assumed that the type IV reaction which is mainly due to T cells in much more concerned with the fibrotic phase, owing to the chronicity of sinusitis.
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