Fig. 2

Probable interplay between auto-antibodies and known contributing factors leading to CRS. Auto-antibodies, whether IgG, IgE or IgA, influence microbial, genetic and immune factors. The latter would probably exert a feed-forward retroaction, leading to increased levels of auto-antibodies. As shown in other auto-immune disorders, different classes of auto-Ig have synergistic effect on other classes. An auto-antibody targeting BP180 could be implicated in CRS pathogenesis. Others are likely to be discovered. Together, these factors maintain the chronic inflammatory state of CRS, with its altered microbial flora, dysfunctional epithelium, impaired barrier function and self-propagating inflammation