Role of staphylococcal superantigens in upper airway disease

Curr Opin Allergy Clin Immunol. 2008 Feb;8(1):34-8. doi: 10.1097/ACI.0b013e3282f4178f.


Purpose of review: Chronic rhinosinusitis with nasal polyps often represents a chronic severe inflammatory disease of the upper airways and may serve as a model for lower airway diseases such as late-onset intrinsic asthma. Enterotoxins derived from Staphylococcus aureus have been implicated in the pathophysiology of nasal polyps as disease-modifying factors; recent findings using therapeutic proof-of-concept approaches support this hypothesis.

Recent findings: Nasal polyps (chronic rhinosinusitis with nasal polyps) are characterized by a T-helper-2 dominated cytokine pattern that includes interleukin-5 and formation of immunoglobulin E. This is in contrast to chronic rhinosinusitis without polyps, which exhibits T-helper-1 biased cytokine release. It is now evident that the cytokine environment is decisive regarding the impact of S. aureus derived enterotoxins, which function as superantigens. S. aureus enterotoxin B further shifts the cytokine pattern in nasal polyps toward T-helper-2 cytokines (increases greater than twofold for interleukin-2, interleukin-4 and interleukin-5), but it disfavours the T-regulatory cytokines interleukin-10 and transforming growth factor-beta1. Furthermore, S. aureus derived enterotoxins influence local immunoglobulin synthesis and induce polyclonal immunoglobulin E production, which may contribute to severe inflammation via activation of mast cells.

Summary: From this new understanding of chronic rhinosinusitis with nasal polyps, new therapeutic approaches emerge such as anti-interleukin-5, anti-immunoglobulin E, and antibiotic treatment. These may enlarge the nonsurgical armentarium.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Bacterial Toxins / immunology
  • Chronic Disease
  • Enterotoxins / immunology
  • Humans
  • Immunity, Mucosal
  • Immunoglobulin E / immunology
  • Interleukin-5 / immunology
  • Nasal Polyps / immunology
  • Nasal Polyps / metabolism
  • Nasal Polyps / microbiology*
  • Nasal Polyps / physiopathology
  • Sinusitis / immunology
  • Sinusitis / metabolism
  • Sinusitis / microbiology*
  • Sinusitis / physiopathology
  • Staphylococcal Infections* / immunology
  • Staphylococcal Infections* / metabolism
  • Staphylococcal Infections* / physiopathology
  • Staphylococcus aureus*
  • Superantigens* / immunology
  • Th2 Cells / immunology


  • Bacterial Toxins
  • Enterotoxins
  • Interleukin-5
  • Superantigens
  • enterotoxin F, Staphylococcal
  • Immunoglobulin E
  • enterotoxin B, staphylococcal