Forty-six patients were studied to assess the role of immunological factors in the formation of nasal polyps. Total IgE levels did not correlate with positive skin testing and were generally higher in polyp sac fluid than in corresponding sera. Asthmatics had significantly higher IgE levels in both serum and polyp fluid than nonasthmatics. Specific IgE (RAST) found in polyp specimens could not be detected by conventional skin or serum testing in nine of 15 patients. By direct immunofluorescence IgE was present in 81% of polyp specimens compared with 13% in mucosal controls. These data indicate that nasal polyp formation may be an IgE mediated disease process and conventional skin or serum testing may not detect this local allergic process.