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Effects of Exogenous Interferon Gamma on Patients With Treatment-Resistant Chronic Rhinosinusitis and Dysregulated Interferon Production

A Pilot Study

Harumi Jyonouchi, MD; Sining Sun, DDS; Anne Kelly, MD; Frank L. Rimell, MD

Arch Otolaryngol Head Neck Surg. 2003;129:563-569.

Objective  To evaluate the effects of exogenous interferon gamma treatment in patients with chronic rhinosinusitis and evidence of aberrant production of interferon (IFN-) and its regulatory cytokines.

Methods  Ten patients with treatment-resistant chronic rhinosinusitis (4 males and 6 females) treated with exogenous interferon gamma (50 µg/m²) were retrospectively evaluated by assessing clinical outcomes compared with clinical and laboratory findings before interferon gamma treatment.

Results  Dysregulated IFN- production was suspected to be characterized by (1) decreased interleukin 12 production (n = 1), (2) defects in interleukin 12 receptor signaling (n = 4), (3) intrinsic defects in interleukin 12 (n = 4), and (4) decreased IFN- production. Eight patients had a history of chronic otitis media with positive bacterial cultures of sinus lavage samples. Adverse skin reactions to various antibiotics were reported in 7 patients. Asthma was reported in 4 patients. Along with sinusitis symptoms, these conditions were better controlled in all 9 patients who received exogenous interferon gamma for longer than 3 months. In 1 patient, interferon gamma treatment was discontinued after 3 weeks secondary to "presumed" tremor that was later diagnosed as a tic. Repeated surgical procedures and hospitalizations were reported in 2 patients after interferon gamma treatment secondary to recurrent chronic otitis media/mastoiditis/catheter infection and G-tube leakage. Interferon gamma treatment was discontinued in 1 of these patients because of a concern about neutropenia that occurred after catheter infection. Adverse effects of using exogenous interferon gamma were generally limited to local skin reactions.

Conclusion  Exogenous interferon gamma may be a therapeutic option in a subset of patients with treatment-resistant chronic rhinosinusitis and evidence of dysregulated IFN- production.

From the Departments of Pediatrics (Drs Jyonouchi, Sun, and Kelly) and Otolaryngology (Dr Rimell), School of Medicine, University of Minnesota, Minneapolis. Dr Jyonouchi is now with the Department of Pediatrics, University of Medicine and Dentistry of New Jersey, Newark. The authors have no relevant financial interest in this article.