CD4(+) LYMPHOCYTES ARE INCREASED IN THE SINUS MUCOSA OF CHILDREN WITHCHRONIC SINUSITIS

Objectives: To quantitate lymphocyte subtypes in sinus tissues harvest ed from children with chronic sinusitis and coexisting asthma, allergi es, and cystic fibrosis during functional endoscopic sinus surgery and compare them with those in normal adult sphenoid sinus mucosa. Design : Immunohistochemical staining of surgical specimens with monoclonal a ntibodies against CD4 and CD8 surface antigens. Setting: Tertiary medi cal center. Patients: Thirty-two children who underwent functional end oscopic sinus surgery for chronic sinusitis refractory to medical trea tment (median age, 8 years; range, 2-13 years) were divided into 3 gro ups: 10 with asthma, 15 without asthma, and 7 with cystic fibrosis. Sp henoid sinus mucosa obtained from 10 adults (median age, 70 years) und ergoing transsphenoidal hypophysectomy was used as control tissue. Mai n Outcome Measures: Numbers of CD4(+) and CD8(+) cells in the lamina p ropria and epithelium of surgical specimens. Results: Significantly mo re CD4(+) cells were in the sinus mucosa of patients with chronic sinu sitis than in the normal sinus mucosa (P<.01), but there was no signif icant difference in the number of CD8(+) cells (P=.4). Patients with c hronic sinusitis with asthma, without asthma, and with cystic fibrosis all had increased numbers of CD4(+) cells compared with sphenoid muco sa, with the difference reaching statistical significance only in the subgroup with chronic sinusitis without asthma (P<.001). The numbers o f CD4(+) cells were higher in patients with chronic sinusitis than in the sphenoid mucosa irrespective of allergic status. Significantly mor e CD4(+) than CD8(+) cells were in tissues from the patients with chro nic sinusitis irrespective of concomitant diseases or allergic status. CD4(+) and CD8(+) cells were more numerous in the apical portion of t he submucosa (immediately beneath the epithelium) than in the basal po rtion both in patients with chronic sinusitis and in normal sphenoid t issue. Conclusions: Children with chronic sinusitis have predominance of CD4(+) cells in the sinus mucosa as compared with normal sphenoid t issue. This contrasts with published results in adults with chronic si nusitis, in whom CD8(+) cells predominate in nasal polyps and the subm ucosa, possibly reflecting a difference in the immunologic response of children and adults.