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Favier V, Daveau C, Carsuzaa F, Fieux M, Vandersteen C, Castillo L, Papon JF, de Gabory L, Saroul N, Verillaud B, Rumeau C, Jankowski R, Michel J, de Bonnecaze G, Lecanu JB, Coste A, Béquignon E, Malard O, Mortuaire G. Study protocol: the biologics in severe chronic rhinosinusitis with nasal polyps survey. BMJ Open 2024; 14:e083112. [PMID: 38749694 PMCID: PMC11097834 DOI: 10.1136/bmjopen-2023-083112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/14/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Chronic rhinosinusitis with nasal polyps (CRSwNP) is a frequent condition affecting approximately 2% of the population. Medical treatment consists long-term use of intranasal corticosteroids and short-term use of oral corticosteroids, in adjunct with saline solution rinses. Surgical management is proposed in patients who failed after medical treatment. In France, two biologics are reimbursed in case of severe uncontrolled CRSwNP despite medical treatment and endoscopic sinus surgery. Waiting for head-to-head biologics comparison, studies should report the efficacy and safety of biologics in large real-life cohorts. This study protocol describes the aims and methods of a prospective, observational, national, multicentric cohort of patients with CRSwNP treated with biologics. METHODS AND ANALYSIS The BIOlogics in severe nasal POlyposis SurvEy is a French multicentre prospective observational cohort study. The main aim is to assess the efficacy and tolerance of biologics in patients with CRSwNP, with or without association with other type 2 diseases, and to determine the strategies in case of uncontrolled disease under biologics. Patients over 18 years old requiring biologics for CRSwNP in accordance with its marketing approval in France (ie, severe nasal polyposis, with lack of control under nasal corticosteroid, systemic corticosteroids and surgery) are invited to participate. Collected data include topical history of surgical procedures and biologics, medication and use of systemic corticosteroids, visual analogical scales for specific symptoms, Sino-Nasal Outcome Test-22 questionnaire, nasal polyp score, asthma control test, Lund-Mackay score on CT scan and IgE concentration and eosinophilic count on blood sample. TRIAL REGISTRATION NCT05228041/DRI_2021/0030.
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Affiliation(s)
- Valentin Favier
- Otorhinolaryngology, Head and Neck Surgery and Maxillofacial Surgery department, CHU Montpellier, Montpellier, France
| | - Clémentine Daveau
- Otorhinolaryngology - Head and Neck department, Hospices civils de Lyon, F-69004 Lyon, France
| | - Florent Carsuzaa
- Otorhinolaryngology and Audiophonology department, CHU Poitiers, F-86000 Poitiers, France
| | - Maxime Fieux
- Otorhinolaryngology department, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Clair Vandersteen
- Otorhinolaryngology department, CHU Nice - Université Côte d'Azur, Nice, France
| | - Laurent Castillo
- Otorhinolaryngology department, CHU Nice - Université Côte d'Azur, Nice, France
| | - Jean Francois Papon
- Otorhinolaryngology - Head and neck department - Université Paris-Saclay, Assistance Publique - Hopitaux de Paris - Bicêtre Hospital, Paris, Île-de-France, France
| | - Ludovic de Gabory
- Otorhinolaryngology-Head and Neck Surgery department, CHU Bordeaux, Bordeaux, France
| | - Nicolas Saroul
- Otolaryngology Head and Neck Surgery department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Benjamin Verillaud
- Otorhinolaryngology department, Assistance Publique - Hopitaux de Paris - Lariboisière Hospital, Paris, Île-de-France, France
| | - Cécile Rumeau
- Otorhinolaryngology - Head and Neck department, Université de Lorraine, CHU Nancy, F-54000 Vandoeuvre les Nancy, France
- EA 3450 DevAH - Développement, Adaptation et Handicap. Regulations cardio-respiratoires et de la motricité, Université de Lorraine, Vandoeuvre les Nancy, France
| | - Roger Jankowski
- Otorhinolaryngology - Head and Neck department, Université de Lorraine, CHU Nancy, F-54000 Vandoeuvre les Nancy, France
| | - Justin Michel
- Otorhinolaryngology- Head and Neck department, Aix-Marseille-University, Marseille, France
| | | | - Jean-Baptiste Lecanu
- Otorhinolaryngology - Head and Neck department, Arthur Vernes Institute, F-75006 Paris, France
| | - Andre Coste
- Otorhinolaryngology - Head and Neck department, AP-HP Henri Mondor Hospital, F-94010 Créteil, Île-de-France, France
- National Institute of Health and Medical Research, Paris-Est Creteil Val de Marne University, F-94010 Creteil, Île-de-France, France
| | - Emilie Béquignon
- Otorhinolaryngology - Head and Neck department, Centre Hospitalier Intercommunal Créteil, F-94010 Créteil, France
| | - Olivier Malard
- Otorhinolaryngology department, CHU Nantes, Nantes, France
| | - Geoffrey Mortuaire
- Otorhinolaryngology - Head and neck department - U1286 - INFINITE - Institute for Translational Research in Inflammation, Huriez Hospital, F-59000 Lille, France
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Mandl HK, Miller JE, Beswick DM. Current and Novel Biologic Therapies for Patients with Asthma and Nasal Polyps. Otolaryngol Clin North Am 2024; 57:225-242. [PMID: 37684154 DOI: 10.1016/j.otc.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
A substantial portion of asthma and nasal polyps (NPs) share a common pathogenesis, which includes type 2-mediated inflammation. Distinct endotypes and phenotypes characterizing asthma and chronic rhinosinusitis have been identified. With emerging evidence describing pathophysiology, novel targets for biologic monoclonal antibody treatments have been developed. There are currently six biologic therapies approved by the US Food and Drug Administration to treat asthma, including omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, and tezepelumab, three of these-omalizumab, mepolizumab, and dupilumab-are also approved for NPs.
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Affiliation(s)
- Hanna K Mandl
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Jessa E Miller
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
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Tai J, Jeong Y, Lee K, Park J, Han M, Kim TH. Analysis of age-related prevalence and risk factors of chronic rhinosinusitis with asthma. EAR, NOSE & THROAT JOURNAL 2024; 103:55-61. [PMID: 36032033 DOI: 10.1177/01455613221121022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine age-related risk factors for chronic rhinosinusitis (CRS) with asthma. METHODS Data were obtained from a national survey of non-hospitalized civilians conducted by the Korean Center for Disease Control and Prevention. CRS diagnosis was based on the guidelines of the European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Asthma was judged based on whether the patient had been diagnosed with asthma in the past. Of the 45,811 survey participants, 26,335 were included in the cross-sectional study. Participants included in the study were divided into the control, CRS, and CRS with asthma groups. Age-related risk factors were analyzed in patients aged < 60 or > 60 years. Univariate logistic analyses were performed to evaluate the relationship between groups. Risk factors included age, sex, household income, residence, education level, occupation, and body mass index (BMI). RESULTS Education level (Odds Ratio [OR]: 0.342, P = .0003), BMI (OR: 1.09, P = .0082), and total IgE (TIgE) levels (OR: 5.582, P = .003) were significantly different between the control and the CRS with asthma group. Education level (OR: 0.478, P = .0016) and TIgE levels (OR: 4, P = .0218) were significantly different between the CRS and CRS with asthma groups under 60 years of age. BMI (OR: 1.087, P = .0443; OR: 1.104, P = .0224) showed a significant difference between all three groups with age > 60 years. CONCLUSION Progression to CRS with asthma is influenced by education level, occupation, and TIgE levels in patients under 60 years of age. BMI was the only influencing factor associated with the progression to CRS with asthma in those aged > 60 years.
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Affiliation(s)
- Junhu Tai
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Yujin Jeong
- Biostatistics, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kijeong Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Jaehyung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Munsoo Han
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Tae Hoon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, Korea
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Fieux M, Rumeau C, De Bonnecaze G, Papon JF, Mortuaire G. Surgery for chronic rhinosinusitis with nasal polyps: An update. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:297-304. [PMID: 37838602 DOI: 10.1016/j.anorl.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
This update aimed to evaluate surgical indications in the management of chronic rhinosinusitis with nasal polyps (CRSwNP). It was conducted and reported according to the criteria stipulated by the Synthesis Without Meta-analysis (SwiM) guidelines. From the PubMed-National Library of Medicine database, 1098 articles were identified for the period 2006-2021 using the key words "nasal polyps" and "surgery". After screening and analysis, 39 publications were selected. The efficacy of surgery on functional improvement in CRSwNP, measured by the specific quality-of-life score SNOT-22, is established, and improvement in olfactory function is expected in 50% of patients. The rate of surgical revision is at least 10-15% at 4 years, but the disease can be controlled for several years, with the interval between primary surgery and symptomatic recurrence exceeding 10 years in some cases. The criteria for surgery are not clearly defined in the literature. However, several authors consider failure of ≥ 8 weeks' well-conducted local medical treatment and use of more than 2 courses of systemic corticosteroids as a reliable indication. No studies or meta-analyses are currently available to determine the superiority of one surgical technique over another.
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Affiliation(s)
- M Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France; Université de Paris Est Creteil, Inserm, IMRB, CNRS ERL 7000, 94010 Créteil, France.
| | - C Rumeau
- Service ORL, CHRU-Nancy, université de Lorraine, 54000 Nancy, France; Université de Lorraine, DevAH, 54000 Nancy, France.
| | - G De Bonnecaze
- Université de Lorraine, DevAH, 54000 Nancy, France; Service d'ORL et chirurgie cervico-faciale, pôle clinique des voies respiratoires, hôpital Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse, France; Laboratoire Center for Anthropobiology and Genomics of Toulouse, université Paul-Sabatier Toulouse III, 31059 Toulouse, France.
| | - J F Papon
- Service d'ORL, de chirurgie cervico-faciale, hôpital Kremlin Bicêtre, Assistance publique-Hôpitaux de Paris, 94270 Paris, France; DMU Neuroscience, Le Kremlin-Bicêtre, université Paris-Saclay, Inserm, IMRB, CNRS ERL 7000, 94010 Créteil, France.
| | - G Mortuaire
- Service d'ORL et de chirurgie cervico-faciale, hôpital Huriez, CHU de Lille, rue Michel-Polonovski, 59000 Lille, France; INFINITE - Institute for Translational Research in Inflammation, université de Lille, Inserm U1286, 59000 Lille, France.
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Cui J, Lin W, May BH, Luo Q, Worsnop C, Zhang AL, Guo X, Lu C, Li Y, Xue CC. Orally administered Chinese herbal therapy to assist post-surgical recovery for chronic rhinosinusitis-A systematic review and meta-analysis. PLoS One 2023; 18:e0292138. [PMID: 37797052 PMCID: PMC10553817 DOI: 10.1371/journal.pone.0292138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/07/2023] [Indexed: 10/07/2023] Open
Abstract
This systematic review and meta-analysis aims to: assess the effectiveness and safety of orally administered Chinese herbal medicines (CHMs) as adjuncts to the post-surgical management of chronic rhinosinusitis (CRS); inform clinicians of the current evidence; identify the best available evidence; and suggest directions for further research. Randomised controlled trials (RCTs) were identified from searches of nine databases plus clinical trial registries. Participants were adults and/or children diagnosed with sinusitis or rhinosinusitis, with or without nasal polyps, who had received surgery. Interventions were CHMs used orally following surgery for CRS as additions to conventional post-surgical management. Controls received conventional post-surgical management without CHMs. Studies reported results for Sino-Nasal Outcome Test (SNOT), visual analogue scales (VAS), Lund-Mackay computed tomography score (LM), Lund-Kennedy endoscopic score (LK), mucociliary transport time (MTT), mucociliary transport rate (MTR), mucociliary clearance (MC) or quality of life (QoL). Twenty-one RCTs were included. All used oral CHMs following functional endoscopic sinus surgery (FESS). The pooled results showed no significant difference between groups for SNOT-20 at the end of treatment (EoT) but there was a significant difference at follow up (FU) in favour of additional CHMs. The VAS for total nasal symptoms (VAS-TNS) showed greater improvements in the CHM groups at EoT and FU. Only FU data were reported for LM which showed greater improvement in the CHM groups. LK showed greater improvements at EoT and FU. The measures of mucociliary transport (MTT, MTR, and MC) each showed significantly greater improvement at EoT in the group that received additional CHMs. No study reported QoL. Adverse events were not serious, but reporting was incomplete. The meta-analyses suggested the addition of oral CHMs to conventional management following FESS may improve recovery. However, most studies were not blinded, and substantial heterogeneity was evident in some meta-analyses. Blinded studies are required to further investigate the roles of oral CHMs in post-surgical recovery. Systematic review registration number: The protocol was registered in PROSPERO (CRD42019119586).
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Affiliation(s)
- Jing Cui
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Wenmin Lin
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Otorhinolaryngology Head and Neck Department, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Brian H. May
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Qiulan Luo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Otorhinolaryngology Head and Neck Department, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Christopher Worsnop
- Department of Respiratory Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Anthony Lin Zhang
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Xinfeng Guo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chuanjian Lu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yunying Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Otorhinolaryngology Head and Neck Department, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Charlie C. Xue
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
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Wautlet A, Bachert C, Desrosiers M, Hellings PW, Peters AT. The Management of Chronic Rhinosinusitis With Nasal Polyps (CRSwNP) With Biologics. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2642-2651. [PMID: 37182568 DOI: 10.1016/j.jaip.2023.04.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/11/2023] [Accepted: 04/24/2023] [Indexed: 05/16/2023]
Abstract
Chronic rhinosinusitis with nasal polyps affects a significant portion of the worldwide population. This illness is associated with several chronic conditions and has an important impact on patient quality of life, leading to a great societal economic burden. In recent years, biologic medications have been developed and found to be effective in the treatment of chronic rhinosinusitis with nasal polyps. This review focuses on these treatment options and their ability to improve patient outcomes, including quality of life. It also reviews available evidence with regards to patient selection, monitoring of patients after treatment initiation, and comparison of different biologics and with other treatment options such as sinus surgery.
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Affiliation(s)
- A Wautlet
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - C Bachert
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Munster, Munster, Germany; Department of Otorhinolaryngology, First Affiliated Hospital, Sun Yat-Sen University, International Airway Research Center, Guangzhou, China; Upper Airways Research Laboratory, Department of Otorhinolaryngology, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - M Desrosiers
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Peter W Hellings
- Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium; Upper Airways Research Laboratory, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Anju T Peters
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Petalas K, Goudakos J, Konstantinou GN. Targeting Epithelium Dysfunction and Impaired Nasal Biofilms to Treat Immunological, Functional, and Structural Abnormalities of Chronic Rhinosinusitis. Int J Mol Sci 2023; 24:12379. [PMID: 37569753 PMCID: PMC10419026 DOI: 10.3390/ijms241512379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
Chronic rhinosinusitis (CRS) with (CRSwNP) or without (CRSsNP) nasal polyps is a prevalent and heterogeneous disorder existing as a spectrum of clinical conditions with complex underlying pathomechanisms. CRS comprises a broad syndrome characterized by multiple immunological features involving complex interactions between the genes, the microbiome, host- and microbiota-derived exosomes, the epithelial barrier, and environmental and micromilieu exposures. The main pathophysiological feature is an epithelial barrier disruption, accompanied by microbiome alterations and unpredictable and multifactorial immunologic overreactions. Extrinsic pathogens and irritants interact with multiple epithelial receptors, which show distinct expression patterns, activate numerous signaling pathways, and lead to diverse antipathogen responses. CRSsNP is mainly characterized by fibrosis and mild inflammation and is often associated with Th1 or Th17 immunological profiles. CRSwNP appears to be associated with moderate or severe type 2 (T2) or Th2 eosinophilic inflammation. The diagnosis is based on clinical, endoscopic, and imaging findings. Possible CRS biomarkers from the peripheral blood, nasal secretions, tissue biopsies, and nasally exhaled air are studied to subgroup different CRS endotypes. The primary goal of CRS management is to maintain clinical control by nasal douching with isotonic or hypertonic saline solutions, administration of nasal and systemic steroids, antibiotics, biologic agents, or, in persistent and more severe cases, appropriate surgical procedures.
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Affiliation(s)
| | - John Goudakos
- Department of Otorhinolaryngology-Head and Neck Surgery, 424 General Military Training Hospital, 56429 Thessaloniki, Greece;
| | - George N. Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Dorilaiou 10, Kalamaria, 55133 Thessaloniki, Greece
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Giunta G, Pirola F, Giombi F, Muci G, Pace GM, Heffler E, Paoletti G, Puggioni F, Cerasuolo M, Ferreli F, Salamanca F, Mercante G, Spriano G, Canonica GW, Malvezzi L. Care for Patients with Type-2 Chronic Rhinosinusitis. J Pers Med 2023; 13:jpm13040618. [PMID: 37109003 PMCID: PMC10146372 DOI: 10.3390/jpm13040618] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
In the last 20 years, growing interest in chronic rhinosinusitis (CRS) has become evident in medical literature; nevertheless, it is still difficult to identify the real prevalence of the disease. Epidemiological studies are few and focused on heterogeneous populations and diagnostic methods. Recent research has contributed to identifying CRS as a disease characterized by heterogeneous clinical scenarios, high impact on quality of life, and elevated social costs. Patient stratification with phenotypes and identification of the pathobiological mechanism at the origin of the disease (endotype) and its comorbidities are pivotal in the diagnostic process, and they should be addressed in order to properly tailor treatment. A multidisciplinary approach, shared diagnostic and therapeutic data, and follow-up processes are therefore necessary. Oncological multidisciplinary boards offer models to imitate in accordance with the principles of precision medicine: tracing a diagnostic pathway with the purpose of identifying the patient’s immunological profile, monitoring therapeutical processes, abstaining from having only a single specialist involved in treatment, and placing the patient at the center of the therapeutic plan. Awareness and participation from the patient’s perspective are fundamental steps to optimize the clinical course, improve quality of life, and reduce the socioeconomic burden.
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Affiliation(s)
- Gianmarco Giunta
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Francesca Pirola
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Francesco Giombi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Correspondence:
| | - Giovanna Muci
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Gian Marco Pace
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Giovanni Paoletti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Francesca Puggioni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Michele Cerasuolo
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Otorhinolaryngology Head & Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Via Francesco Nava 31, 20159 Milan, Italy
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Fabrizio Salamanca
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Otorhinolaryngology Head & Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Via Francesco Nava 31, 20159 Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Luca Malvezzi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Otorhinolaryngology Head & Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Via Francesco Nava 31, 20159 Milan, Italy
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Yao Y, Zhu HY, Zeng M, Liu Z. Immunological mechanisms and treatable traits of chronic rhinosinusitis in Asia: A narrative review. Clin Otolaryngol 2023; 48:363-370. [PMID: 36317525 DOI: 10.1111/coa.14001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/23/2022] [Accepted: 10/16/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To review the current literature on immunological mechanisms and treatable traits of chronic rhinosinusitis (CRS) in Asia. DESIGN This is a narrative review of published data on the immunological mechanisms and treatable traits of CRS in Asia. Published English literature on CRS in Asian and Western countries was reviewed. Where available, the data extracted included epidemiology, immunology, bacterium, phenotype, endotype and treatment. RESULTS AND CONCLUSION CRS is a heterogeneous disease characterised by persistent locoregional mucosal inflammation of the paranasal sinuses. The inflammatory signatures of CRS vary across patients with distinct racial and ethnic backgrounds and geographic areas. Compared to CRS patients in Western countries, Asian CRS patients display less eosinophilic and Type 2 inflammation, which is associated with lower asthma and allergic rhinitis comorbidities. In contrast, Asian patients with CRS have more prominent non-eosinophilic inflammation than those in Western countries. In addition, Asian CRS patients may have different bacterial colonisation than patients in Western countries. Our review suggests that the distinct immunological mechanisms between Asian and Western CRS patients may influence the clinical phenotype, responses to treatment and outcomes. The treatable trait is a new strategy and therapeutic target identified by phenotype or endotype and has been proposed as a new paradigm for the management of diseases. Improved understanding of CRS phenotypic and endotypic heterogeneity and incorporation of treatable traits into clinical care pathways may facilitate more effective selections of therapeutic interventions, including surgery and biologics.
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Affiliation(s)
- Yin Yao
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.,Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, Hubei, People's Republic of China
| | - Hong-Yu Zhu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Ming Zeng
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.,Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, Hubei, People's Republic of China
| | - Zheng Liu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.,Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, Hubei, People's Republic of China
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10
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Klimek L, Förster-Ruhrmann U, Olze H, Beule AG, Chaker AM, Hagemann J, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Strieth S, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Becker S, Bärhold F, Klimek F, Casper I, Zuberbier J, Rudack C, Cuevas M, Hintschich CA, Guntinas-Lichius O, Stöver T, Bergmann C, Werminghaus P, Pfaar O, Gosepath J, Gröger M, Beutner C, Laudien M, Weber RK, Hildenbrand T, Hoffmann AS, Bachert C. Empfehlungen zur Überprüfung der Wirksamkeit und Verlaufsdokumentation von Mepolizumab bei chronischer Rhinosinusitis mit Nasenpolypen (CRSwNP) im deutschen Gesundheitssystem – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNOKHC). Laryngorhinootologie 2023; 102:89-99. [PMID: 36750110 DOI: 10.1055/a-2003-4730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the mucous membranes of the nose and sinuses. Eosinophilic inflammation is described as a common endotype. The anti-IL5 antibody mepolizumab was approved in November 2021 as an add-on therapy to intranasal glucocorticosteroids for the treatment of adults with severe chronic rhinosinusitis with nasal polyps when systemic glucocorticosteroids or surgery do not provide adequate disease control. While national and international recommendations exist for the use of mepolizumab in CRSwNP, it has not yet been adequately specified how this therapy is to be monitored, what follow-up documentation is necessary, and when it should be terminated if necessary. METHODS A literature search was performed to analyze previous data on the treatment of CRSwNP with mepolizumab and to determine the available evidence by searching Medline, Pubmed, the national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to and including 10/2022 were considered. RESULTS Based on the international literature and previous experience by an expert panel, recommendations for follow-up, adherence to therapy intervals and possible therapy breaks, as well as termination of therapy when using mepolizumab for the indication CRSwNP in the German health care system are given on the basis of a documentation sheet. CONCLUSIONS Understanding the immunological basis of CRSwNP opens up new non-surgical therapeutic approaches with biologics for patients with severe, uncontrolled courses. Here, we provide recommendations for follow-up, adherence to therapy intervals, possible therapy pauses, or discontinuation of therapy when mepolizumab is used as add-on therapy with intranasal glucocorticosteroids to treat adult patients with severe CRSwNP that cannot be adequately controlled with systemic glucocorticosteroids and/or surgical intervention.
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Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - U Förster-Ruhrmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - H Olze
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - A G Beule
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster.,Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie der Universitätsmedizin Greifswald
| | - A M Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München.,Zentrum für Allergie und Umwelt (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - J Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Ruhr-Universität Bochum, St.-Elisabeth-Hospital
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - S Strieth
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Bonn
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Wiesbaden
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - S Becker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen
| | - F Bärhold
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen
| | - F Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - I Casper
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - J Zuberbier
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - C Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - C A Hintschich
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg
| | | | - T Stöver
- Universitäts-Hals-Nasen-Ohrenklinik Frankfurt am Main
| | - C Bergmann
- Praxis für Hals-Nasen-Ohrenheilkunde, Klinik RKM 740, Düsseldorf
| | - P Werminghaus
- Praxis für Hals-Nasen-Ohrenheilkunde und Allergologie, Düsseldorf
| | - O Pfaar
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg
| | - J Gosepath
- Klinik für Hals-, Nasen- und Ohrenheilkunde, HSK Wiesbaden
| | - M Gröger
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum LMU München
| | - C Beutner
- Klinik für Dermatologie, Venerologie und Allergologie, Allergiezentrum Südniedersachsen, Universitätsmedizin Göttingen
| | - M Laudien
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Kiel
| | - R K Weber
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe
| | - T Hildenbrand
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg
| | - A S Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf
| | - C Bachert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gent, Belgien
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11
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Seys SF, Hellings PW, Alobid I, Backer V, Bequignon E, von Buchwald C, Cavaliere C, Coste A, Deneyer L, Diamant Z, Eckl-Dorna J, Fokkens WJ, Gane S, Gevaert P, Holbaek-Haase C, Holzmeister C, Hopkins C, Hox V, Huart C, Jankowski R, Jorissen M, Kjeldsen A, Knipps L, Lange B, van der Lans R, Laulajainen-Hongisto A, Larsen K, Liu DT, Lund V, Mariën G, Masieri S, Mortuaire G, Mullol J, Reitsma S, Rombaux P, Schneider S, Steinsvik A, Tomazic PV, Toppila-Salmi SK, Van Gerven L, Van Zele T, Virkkula P, Wagenmann M, Bachert C. Chronic Rhinosinusitis Outcome Registry (CHRINOSOR): Establishment of an International Outcome Registry Driven by mHealth Technology. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:431-438.e2. [PMID: 36272718 DOI: 10.1016/j.jaip.2022.09.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Real-world evidence (RWE) is a valuable instrument to better understand the patient journey and effectiveness of therapies. RWE on the prevalence of uncontrolled chronic rhinosinusitis (CRS) and CRS natural course of disease across Europe is scarce. In addition, there is limited RWE that enables comparison of the effectiveness of marketed therapies including topical or systemic corticosteroids, sinus surgery, or biologics. OBJECTIVE To establish an international CHRonic rhINOSinusitis Outcome Registry (CHRINOSOR) based on real-world data collection enabled by mobile health technology. METHODOLOGY A digital platform, Galenus Health, supporting patients and physicians in the management of chronic respiratory diseases, is used to collect data on patient profile, disease history, patient outcomes, and a set of relevant clinical outcomes. Adult patients with a diagnosis of CRS are eligible for inclusion. RESULTS A collaborative scientific network of 17 university ear-nose-throat (ENT) clinics from 10 European countries has been established with the aim to collect real-world data in a longitudinal and standardized manner. The Galenus Health digital platform is currently being implemented in these ENT clinics taking into account legal, privacy, and data security aspects. Up to 300 patients have already been included. CONCLUSIONS CHRINOSOR is a collaborative effort that aims at improving our understanding of CRS, its comorbidities, and the effectiveness of its treatments. Ultimately, these insights will guide us as scientific community to develop future care pathways informed by RWE.
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Affiliation(s)
- Sven F Seys
- Research Department, Galenus Health, Belgium; Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
| | - Peter W Hellings
- Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium; Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Otorhinolaryngology, Amsterdam University Medical Centres, Academic Medical Center, Amsterdam, the Netherlands
| | - Isam Alobid
- Rhinology and Skull Base Surgery Unit, Otorhinolaryngology Department, Hospital Clinic, IDIBAPS, Ciberes, Barcelona, Spain
| | - Vibeke Backer
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Emilie Bequignon
- Service d'ORL et de chirurgie cervico-faciale, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Carlo Cavaliere
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - André Coste
- Service d'ORL et de chirurgie cervico-faciale, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Zuzana Diamant
- Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium; Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden; Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; Department of Clin Pharm and Pharmacol, University Groningen, Univ Med Ctr Groningen, Groningen, the Netherlands
| | - Julia Eckl-Dorna
- Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital (AKH), Medical University of Vienna, Vienna, Austria
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Academic Medical Center, Amsterdam, the Netherlands
| | - Simon Gane
- Department of Rhinology, Royal National Ear, Nose, Throat and Eastman Dental Hospital, UCLH, London, United Kingdom
| | - Philippe Gevaert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - Christiane Holbaek-Haase
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Clemens Holzmeister
- Department of General ORL, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Claire Hopkins
- ENT Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Valérie Hox
- Service d'Otorhinolaryngologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Caroline Huart
- Service d'Otorhinolaryngologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Roger Jankowski
- ENT Department, Hospital of Nancy, Brabois-ILM, University Lorraine, Nancy, France
| | - Mark Jorissen
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Laboratory of Experimental Otorhinolaryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Anette Kjeldsen
- Department of Otorhinolaryngology, Odense University Hospital, Odense, Denmark
| | - Lisa Knipps
- Department of Otorhinolaryngology, Universitätsklinikum Düsseldorf, Dusseldorf, Germany
| | - Bibi Lange
- Department of Otorhinolaryngology, Odense University Hospital, Odense, Denmark
| | - Rik van der Lans
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Academic Medical Center, Amsterdam, the Netherlands
| | - Anu Laulajainen-Hongisto
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kenneth Larsen
- Department of Otorhinolaryngology, Odense University Hospital, Odense, Denmark
| | - David T Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital (AKH), Medical University of Vienna, Vienna, Austria
| | - Valerie Lund
- Department of Rhinology, Royal National Ear, Nose, Throat and Eastman Dental Hospital, UCLH, London, United Kingdom
| | - Gert Mariën
- Research Department, Galenus Health, Belgium
| | - Simonetta Masieri
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Geoffrey Mortuaire
- Otorhinolaryngology-Head and Neck Department, Huriez Hospital, Centre Hospitalier Universitaire (CHU) Lille, Lille, France
| | - Joaquim Mullol
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, IDIBAPS, CIBERES, Barcelona, Catalonia, Spain
| | - Sietze Reitsma
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Academic Medical Center, Amsterdam, the Netherlands
| | - Philippe Rombaux
- Service d'Otorhinolaryngologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Sven Schneider
- Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital (AKH), Medical University of Vienna, Vienna, Austria
| | - Andreas Steinsvik
- Department of Otorhinolaryngology, Akershus University Hospital, Lorenskog, Norway
| | - Peter-Valentin Tomazic
- Department of General ORL, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Sanna K Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Laura Van Gerven
- Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium; Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Laboratory of Experimental Otorhinolaryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Thibaut Van Zele
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - Paula Virkkula
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Martin Wagenmann
- Department of Otorhinolaryngology, Universitätsklinikum Düsseldorf, Dusseldorf, Germany
| | - Claus Bachert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium; Division of ENT Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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12
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Grimm D, Hwang PH, Lin YT. The link between allergic rhinitis and chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 2023; 31:3-10. [PMID: 36729858 DOI: 10.1097/moo.0000000000000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Allergic rhinitis and chronic rhinosinusitis (CRS) are common disorders affecting millions of people worldwide. Although allergic rhinitis and CRS are distinct clinical entities, certain CRS endotypes share similar pathological mechanisms as those seen in patients with allergic rhinitis. This review assesses the literature behind the similarities and differences seen in patients with CRS and allergic rhinitis, and the role atopy might play in the pathophysiology of CRS. RECENT FINDINGS In examining the associations between allergic rhinitis and CRS, most studies have focused primarily on CRS with nasal polyps and type 2 inflammation in CRS. Recent studies have demonstrated the similarities and differences in pathologic mechanisms behind allergic rhinitis and CRS, with an emphasis on patient endotypes, genetics, and the nasoepithelial immunologic barrier. Related immunopathology shared by allergic rhinitis and type 2 inflammation in CRS has allowed for therapeutic overlap with biologic treatments. SUMMARY Allergic rhinitis and CRS often present as comorbid conditions, and understanding the relationship between allergic rhinitis and CRS is important when considering treatment options. Advances in understanding the genetics and immunology, as well as biologic and immunotherapeutic treatments have improved outcomes in patients with CRS, especially in the setting of atopy.
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Affiliation(s)
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Yi-Tsen Lin
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
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13
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Zhang L, Zhang R, Pang K, Liao J, Liao C, Tian L. Prevalence and risk factors of chronic rhinosinusitis among Chinese: A systematic review and meta-analysis. Front Public Health 2023; 10:986026. [PMID: 36699933 PMCID: PMC9869174 DOI: 10.3389/fpubh.2022.986026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/07/2022] [Indexed: 01/12/2023] Open
Abstract
Background Chronic rhinosinusitis (CRS) can be seen in people of all ages. CRS heavily affects the quality of a patient's daily life and also causes tremendous economic burdens on patients' families and society. The prevalence of CRS in different countries varies and no systematic review of the prevalence of CRS among Chinese has been published previously. The objective of this systematic review and meta-analysis is to determine the prevalence of CRS among Chinese and to explore the main risk factors of CRS among Chinese. Methods Using relevant keywords, data resources including PubMed, Scopus, Web of Science, Google Scholar, Embase, Cochrane Library, Chinese National Knowledge of Infrastructure (CNKI), WANGFANG, VIP, and China Biomedical Literature database (CMB) were searched to obtain literature reporting the prevalence of and risk factors of CRS among Chinese which were clearly diagnosed with CRS from inception to 30 June 2022. The random/fixed effect model was used for meta-analysis, and the I2 index was employed to assess heterogeneity among studies. All analyses were performed by using the STATA version 16.0 software. The study was registered with PROSPERO, register number. CRD42022341877. Result A total of 12 relevant kinds of literature were qualified for the present systematic review, including 4,033 patients. The results showed that the overall prevalence of CRS among Chinese was 10% (95%CI: 0.06-0.13, I2 = 99.6%, P < 0.001). The prevalence of CRS among Chinese who lived in urban cities was 18% (95%CI: -0.07 to 0.43, I2 = 99.9%, P < 0.001), which was obviously lower than the prevalence of CRS among Chinese who lived in rural areas (27%, 95%CI: -0.14 to 0.68, I2 = 99.8%, P < 0.001). The prevalence of CRS among Chinese before 2010 was 23% (95%CI: -0.05 to 0.50, I2 = 99.8%, P < 0.001), which was remarkably higher than the prevalence of CRS among Chinese after 2010 (7%, 95%CI: 0.05-0.09, I2 = 99.0%, P < 0.001). The prevalence of CRS among Chinese who were divorced was 17% (95%CI: 0.12-0.22, I2 = 0.0%, P = 0.436), while the prevalence of CRS among Chinese who were married, widowed, and unmarried was 9% (95%CI: 0.06-0.11, I2 = 88.1%, P = 0.004), 9% (95%CI: 0.06-0.11, I2 = 0.0%, P = 0.863), and 9% (95%CI: 0.08-0.10, I2 = 0.0%, P = 0.658), respectively. The prevalence of CRS among Han and minority Chinese was 8% (95%CI: 0.07-0.10, I2 = 69.6%, P = 0.070) and 12% (95%CI: 0.10-0.15, I2 = 38.6%, P = 0.202), respectively. The prevalence of CRS among Chinese who was never exposed to moldy or damp environments was 8% (95%CI: 0.08-0.09, I2 = 0.0%, P = 0.351), the prevalence of CRS among Chinese who was occasionally exposed to moldy or damp environments was 16% (95%CI: 0.10-0.22, I2 = 78.9%, P = 0.030), and the prevalence of CRS among Chinese who was frequently or every day exposed to moldy or damp environments was up to 20% (95%CI: 0.15-0.24, I2 = 0.0%, P = 0.558). Conclusion This meta-analysis shows that the prevalence of CRS among Chinese is at a high level. People who have some risk factors, such as occasional or frequent or everyday exposure to moldy or damp environments, have a higher prevalence of CRS. We should attach more importance to the risk factors of CRS in clinical practice and disseminate scientific information and carry out education to lower the prevalence of CRS in China. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=341877, identifier: CRD42022341877.
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Affiliation(s)
- Lan Zhang
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Rong Zhang
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Kaiyun Pang
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jie Liao
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chao Liao
- Department of Otorhinolaryngology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Li Tian
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China,Department of Otorhinolaryngology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China,*Correspondence: Li Tian ✉
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14
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Naclerio R, Mullol J, Stevens WW. A Decade of Clinical Advances in Chronic Rhinosinusitis: 2012-2022. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:43-50. [PMID: 36610759 DOI: 10.1016/j.jaip.2022.10.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 01/07/2023]
Abstract
The field of chronic rhinosinusitis (CRS) is constantly evolving. In the past 10 years, key advancements in basic and translational research as well as clinical studies have improved our understanding and management of CRS. Notably, treatment options have expanded to include novel therapeutic drugs, devices, and surgical techniques. Assessments of patient symptoms and their impact on quality of life have become more standardized. Progress has also been made in both determining the true prevalence of CRS and recognizing comorbidities that can impact CRS severity. Practice guidelines have also shifted from expert opinion to more data-driven analyses. This review highlights major clinical advancements made in the field of CRS over the past 10 years as well as identifies current gaps in knowledge that can form the basis for new areas of study over the next decade.
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Affiliation(s)
- Robert Naclerio
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Md
| | - Joaquim Mullol
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clinic Barcelona, University of Barcelona; Clinical and Experimental Respiratory Immunoallergy, Institute of Biomedical Investigations 'August Pi i Sunyer' (IDIBAPS) Centre for Biomedical Investigations in Respiratory Diseases (CIBERES), Institute of Health Carlos III, Barcelona, Catalonia, Spain
| | - Whitney W Stevens
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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15
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Quality of life in CRSwNP: evaluation of ACCESS and Lund-Mackay computed tomography scores versus the QoL questionnaire. Eur Arch Otorhinolaryngol 2022; 279:5721-5725. [PMID: 35717639 DOI: 10.1007/s00405-022-07494-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/07/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Recently, a new CT scan classification of the extent of previous endoscopic sinus surgery called The Amsterdam Classification of Completness of Endoscopic Sinus Surgery (ACCESS) was published. The aim of this study was to investigate possible associations between traditionally used Lund-Mackay CT score and ACCESS score and their possible relationship to pre- and postoperative quality of life in a narrowly defined group of patients with recurrent CRSwNP. METHODS Forty-nine patients who underwent a revision ESS for CRSwNP were enrolled in a retrospective study. CT imaging scans were evaluated, LM and ACCESS scores determined. All patients completed the validated Czech version of the SNOT-22 questionnaire before and 6 months after surgery. The correlation between the two CT scores and the QoL questionnaire was tested using Pearson's correlation tests. RESULTS No correlation was demonstrated between LM scores and patient-based SNOT-22 scores neither preopratively nor postoperatively (r = - 0.0580; p = 0.918 and r = 0.0252; p = 0.8634, respectively. Similarly, no correlation was found between the ACCESS score and SNOT-22 before and after surgery (r = - 0.1988; p = 0.1708 and r = - 0.943; p = 0.5193, respectively). No linear relationship was demonstrated between the LM score and the ACCESS score (r = 0.075; p = 0.6053). CONCLUSIONS The results show that even the CT score evaluating the completeness of previous procedures has no linear relationship to the quality of life preoperatively and cannot serve as a predictor for the outcomes of surgical treatment. This study also confirms that ACCESS evaluates a different aspect of the radiological finding than the traditionally used LM score.
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16
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Ceballos Cantu JC, Alobid I, Mullol J. Current evaluation and management of patients with chronic rhinosinusitis and nasal polyps. Expert Rev Clin Immunol 2022; 18:1253-1263. [PMID: 36196875 DOI: 10.1080/1744666x.2022.2128767] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION A clear understanding of the pathophysiology of chronic rhinosinusitis with nasal polyps (CRSwNP) and its close association with other airway pathologies, especially asthma, helps to comprehend the concept of the united airway and the importance of a multidisciplinary approach and the actual roll of biologic therapy. AREAS COVERED This expert review is the synthesis of a working group on the current state of the art of the evaluation and management of CRSwNP. A thorough analysis of the literature has been conducted for the latest studies and results, specially the European (EPOS 2020) and American (ICAR-RS 2021) guidelines. EXPERT OPINION The roles of optimal medical treatment and indications for surgery are becoming clearer, but much research is still needed regarding the extent and radicality when surgery is indicated. The main objectives of this review were to provide a clear and updated description of treatments, their indication, follow-up, and response criteria. These steps are considering the broad spectrum of inflammation endophenotypes and the biologic therapy available. Understanding the role and limitations of each specialty is key for providing greatest benefit to the patient.
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Affiliation(s)
- Juan Carlos Ceballos Cantu
- Rhinology Unit & Smell Clinic, Otorhinolaryngology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Rhinology and Skull Base Unit, Otorhinolaryngology Department, Hospital Clinic, Universitat de Barcelon, Barcelona, Spain
| | - Isam Alobid
- Rhinology Unit & Smell Clinic, Otorhinolaryngology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Rhinology and Skull Base Unit, Otorhinolaryngology Department, Hospital Clinic, Universitat de Barcelon, Barcelona, Spain.,Clinical & Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Biomedical Reaserch Networking Centers of Respiratiry Diseases (CIBERES), Madrid, Spain
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, Otorhinolaryngology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Clinical & Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Biomedical Reaserch Networking Centers of Respiratiry Diseases (CIBERES), Madrid, Spain
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17
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Murali S, Arunachalam R, Saravanam PK, Thattarakkal VR. Assessment of Olfaction Following Endoscopic Sinus Surgery. Indian J Otolaryngol Head Neck Surg 2022; 74:1353-1360. [PMID: 36452713 PMCID: PMC9702161 DOI: 10.1007/s12070-021-02500-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/02/2021] [Indexed: 10/21/2022] Open
Abstract
To assess the olfactory outcomes following Endoscopic Sinus Surgery (ESS) in patients diagnosed with Chronic Rhinosinusitis (CRS) and Sinonasal polyposis (SNP). To assess and compare the pre-operative and post-operative olfactory scores of patients undergoing ESS/ ESS + polypectomy/ESS + Septoplasty by subjective and objective methods. This is a prospective, cohort study which included a total of 60 patients. Subjective assessment was done using a Questionnaire. Preoperative olfactory assessment was performed with Sniffing Sticks. Olfactory assessment was done at 1st,3rd, 6th and 12th week following surgery. The preoperative and postoperative scores were statistically analysed and compared. In patients who underwent ESS, there was a significant reduction in olfactory scores in the immediate few weeks after surgery which improved over time by the end of 3 months. In patients who underwent ESS with polypectomy, there was a significant improvement in olfactory scores from the third week following surgery which was sustained over 3rd month follow-up. In patients who underwent ESS with Septoplasy, there was a significant decrease in olfactory scores during the initial few weeks with a marginal improvement during 3 months follow-up. At the end of 12 weeks post ESS, no patient was found to be anosmic. Patients with pre-existing hyposmia did not show statistically significant change post surgery.However patients with anosmia showed statistically significant improvement in olfactory function, but did not become normosmic at 12th post-operative week. Majority of normosmics did not have alteration in their olfactory perception at 12th post-operative week.
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Affiliation(s)
- Shivagamasundari Murali
- Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu 600116 India
| | - Ravikumar Arunachalam
- Department of ENT, Head and Neck Surgery, SRM Medical College Hospital and Research Center, Chengalpet, Chennai, Tamil Nadu 603203 India
| | - Prasanna Kumar Saravanam
- Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu 600116 India
| | - Vinay Raj Thattarakkal
- Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu 600116 India
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18
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Nocera AL, Mueller SK, Workman AD, Wu D, McDonnell K, Sadow PM, Amiji MM, Bleier BS. Cystatin SN is a potent upstream initiator of epithelial-derived type 2 inflammation in chronic rhinosinusitis. J Allergy Clin Immunol 2022; 150:872-881. [PMID: 35660375 PMCID: PMC9547833 DOI: 10.1016/j.jaci.2022.04.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/30/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cystatin SN (CST1) and cystatin SA (CST2) are cysteine protease inhibitors that protect against allergen, viral, and bacterial proteases. Cystatins are overexpressed in the setting of allergic rhinitis and chronic rhinosinusitis with nasal polyps (CRSwNP); however, their role in promoting type 2 inflammation remains poorly characterized. OBJECTIVE The purpose of this study was to use integrated poly-omics and a murine exposure model to explore the link between cystatin overexpression in CRSwNP and type 2 inflammation. METHODS In this institutional review board- and institutional animal care and use committee-approved study, we compared tissue, exosome, and mucus CST1 and CST2 between CRSwNP and controls (n = 10 per group) by using matched whole exome sequencing, transcriptomic, proteomic, posttranslational modification, histologic, functional, and bioinformatic analyses. C57/BL6 mice were dosed with 3.9 μg/mL of CST1 or PBS intranasally for 5 to 18 days in the presence or absence of epithelial ABCB1a knockdown. Inflammatory cytokines were quantified by using Quansys multiplex assays or ELISAs. RESULTS Of the 1305 proteins quantified, CST1 and CST2 were among the most overexpressed protease inhibitors in tissue, exosome, and mucus samples; they were localized to the epithelial layer. Multiple posttranslational modifications were identified in the polyp tissue. Exosomal CST1 and CST2 were strongly and significantly correlated with eosinophils and Lund-Mackay scores. Murine type 2 cytokine secretion and TH2 cell infiltration increased in a time-dependent manner following CST1 exposure and was abrogated by epithelial knockdown of ABCB1a, a regulator of epithelial cytokine secretion. CONCLUSION CST1 is a potent upstream initiator of epithelial-derived type 2 inflammation in CRSwNP. Therapeutic strategies targeting CST activity and its associated posttranslational modifications deserve further interrogation.
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Affiliation(s)
- Angela L Nocera
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass; Department of Pharmaceutical Sciences, School of Pharmacy, Northeastern University, Boston, Mass
| | - Sarina K Mueller
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass; Department of Otolaryngology/Head and Neck Surgery, University of Erlangen-Nuremberg, Nuremberg, Germany
| | - Alan D Workman
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass
| | - Dawei Wu
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass
| | - Kristen McDonnell
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Mansoor M Amiji
- Department of Pharmaceutical Sciences, School of Pharmacy, Northeastern University, Boston, Mass
| | - Benjamin S Bleier
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass.
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19
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Sanchez-Collado I, Mora T, Munoz-Cano R, Ribo P, Mullol J, Valero A. Prevalence of Chronic Rhinosinusitis with Nasal Polyps in Catalonia (Spain): a retrospective, large-scale population-based study. Rhinology 2022; 60:384-396. [DOI: 10.4193/rhin21.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background: Studies on the prevalence of chronic rhinosinusitis (CRS) with nasal polyps (NP) in general-based populations are scarce in Europe and worldwide. We performed a retrospective population-based observational cohort study of 30,189 adult patients diagnosed with NP in Catalonia (Spain). Methodology: Adult individuals (≥18 years old) with a diagnosis of NP established by medical records at different health care levels (primary, hospital, and emergency) from the Catalan Health System (CHS) were included. Socio-demographic characteristics, prevalence, overall and by age and gender, disease severity, multi-morbidities, and biomarkers of type-2 inflammation were evaluated, together with appropriate medical treatment (AMT) and Endoscopic Sinus Surgery (ESS). Results: In general population and severity sub-populations, the overall diagnosed NP prevalence was 0.49% and higher for males than females (0.60% vs 0.39%, p less than 0.0016). The prevalence for the severe NP population was 0.12%. The NP prevalence increased with age, the highest being at ≥ 60 years old for both gender and severity groups. Asthma (40.1%), acute rhinosinusitis (41.1%), and allergic rhinitis (32.1%) were among the most frequent comorbid respiratory diseases. ESS was performed in 15.4% of NP patients. Type 2 inflammation was present in 83.8% of the NP population and was more frequent in severe than non-severe (87.1% vs 82.7%, p less than 0.0001) patients and in those with respiratory multi-morbidities (91%). Conclusions: This is the first large-scale population-based NP epidemiology study conducted in Spain, including severity based on undergoing medical and surgical treatment and type 2 inflammation. Although the prevalence data are lower than in previous European studies, the large NP cohort studied represents an essential strength of the results.
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20
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Li F, Wang X, Shen S, Huang K, Wang M, Liu X, Wang C, Jin J, Zhang L. Risk factors associated with comorbid asthma in patients with chronic rhinosinusitis with nasal polyps: a cross-sectional study. BMC Pulm Med 2022; 22:338. [PMID: 36071399 PMCID: PMC9454111 DOI: 10.1186/s12890-022-02138-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022] Open
Abstract
Background Although 20–60% of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have asthma, the risk factors associated with comorbid asthma are not clear. The aim of the study was to investigate the factors associated with asthma, and develop a practical scoring system to screen asthma comorbidity in CRSwNP patients.
Methods This report describes a cross-sectional study with consecutive CRSwNP patients. Two cohorts of CRSwNP patients named “modelling” group and “validation” group were investigated respectively. Logistic regression analysis was performed based on demographic and clinical data collected from patients in the modelling group to determine the risk factors associated with asthma, and establish a scoring system for screening comorbid asthma. Receiver operating characteristic curve was constructed to evaluate the screening system; the optimal cut-off point was established by means of the Yoden Index. The consistency between the diagnosis of asthma by the Global Initiative for Asthma (GINA) criteria and by the screening system was assessed by Kappa value in the validation group. Results Totally 150 patients in modelling group and 78 patients in validation group were enrolled. Female gender (odds ratio [OR] = 6.4; P < 0.001), allergic rhinitis (OR = 2.9; P = 0.021), serum total (T)-immunoglobulin (Ig) E ≥ 69.0kU/L (OR = 12.0; P < 0.001), and blood eosinophil count ≥ 0.35 × 109/L (OR = 4.0; P = 0.001) were shown to be independent risk factors for asthma in patients with CRSwNP. Based on these variables, a scoring system (FAIE) ranging from 0(no risk) to 6(high risk); was developed. The area under the receiver operating characteristic curve of the system was 0.823, and the optimal cut-off value was 3 points, with sensitivity 83.8% and specificity 68.6% for screening asthma. The asthma comorbidity determined with FAIE score ≥ 3 points in the validation group, was moderately consistent with that defined by GINA (Kappa = 0.513, P < 0.001), with sensitivity 76.9% and specificity 74.4%. Conclusions Female gender, allergic rhinitis, serum T-IgE level, and blood eosinophil count are independent risk factors for asthma comorbidity in patients with CRSwNP, and the FAIE system may be practical for screening comorbid asthma in these patients.
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Affiliation(s)
- Fangyuan Li
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China
| | - Xuechen Wang
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China
| | - Shen Shen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Kai Huang
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China
| | - Ming Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Xiaofang Liu
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Jianmin Jin
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China. .,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China. .,Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China. .,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.
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21
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Starry A, Hardtstock F, Wilke T, Weihing J, Ultsch B, Wernitz M, Renninger M, Maywald U, Pfaar O. Epidemiology and treatment of patients with Chronic rhinosinusitis with nasal polyps in Germany-A claims data study. Allergy 2022; 77:2725-2736. [PMID: 35357726 PMCID: PMC9542419 DOI: 10.1111/all.15301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND There are different levels of severity among patients who suffer from chronic rhinosinusitis with nasal polyps (CRSwNP). In this study, the epidemiology of CRSwNP and severe CRswNP was estimated. METHODS A retrospective claim data analysis was conducted on adult CRSwNP patients (ICD-10: J33), and those classified as severe CRSwNP patients with inadequate disease control (based upon combinations of previous and current treatments) between 2015 and 2019. Prevalence and incidence figures were calculated and extrapolated to the German population. In addition, baseline characteristics and treatment outcomes were analysed. RESULTS Overall, the 5-year prevalence of adult CRSwNP cases from 2015 to 2019 in Germany was 374,115 cases (about 5500 per million), with 12,989 (about 200 per million) patients being classified as severe CRSwNP with inadequate disease control, whereas 267,880 (about 3900 per million) patients were identified as having an incident CRSwNP diagnosis between 2016 and 2019. From the incident CRSwNP cohort, 80.55% had received at least one intranasal corticosteroid (INCS), 24.27% received at least 1 systemic corticosteroid (SCS), and 17.33% received at least one functional endoscopic sinus surgery (FESS) within 12 months after their incident diagnosis. CONCLUSION Severe CRSwNP with inadequate disease control affects about 200 per million people in Germany. INCS is the first-choice treatment for most CRSwNP patients; however, for patients with severe CRSwNP, SCS are prescribed more frequently and long-term effects of these should be further investigated, especially if despite treatment, adequate disease control cannot be achieved.
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Affiliation(s)
| | | | - Thomas Wilke
- Institut für Pharmakoökonomie und Arzneimittellogistik e.V.WismarGermany
| | | | | | | | | | | | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck SurgerySection of Rhinology and AllergyPhilipps‐Universität MarburgUniversity Hospital MarburgMarburgGermany
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22
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Haxel B, Hummel T, Fruth K, Lorenz K, Gunder N, Nahrath P, Cuevas M. Real-world-effectiveness of biological treatment for severe chronic rhinosinusitis with nasal polyps. Rhinology 2022; 60:435-443. [DOI: 10.4193/rhin22.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background: During the last two years, three different monoclonal antibodies have been approved in many countries for the treatment of patients suffering from severe chronic rhinosinusitis with nasal polyps (CRSwNP). Their efficacy has been demonstrated through large double-blind placebo-controlled clinical studies. Until now, only very limited reports on real-world data regarding this therapy have been published. Methods: This per protocol analysis included patients with an indication for biological treatment because of uncontrolled CRSwNP, despite long-term nasal steroid treatment, systemic steroid use and/ or endonasal sinus surgery. Baseline data on demographics, medical history and comorbidities, polyp score, quality of life and sense of smell (using Sniffin´ Sticks) were assessed and a treatment with either dupilumab or omalizumab was started. The patients were followed up after three and six months. The changes in polyp score, quality-of-life measures and olfaction were noted. Results: 70 consecutive patients were evaluated during the study. Of the patients, 49 were treated with dupilumab and 21 with omalizumab. The polyp score decreased significantly after three and six months, and the quality-of-life parameters and olfaction increased. More than 90% of patients showed a moderate to excellent response to the therapy and there was no difference in the overall response between the two treatments. Olfaction improved in two thirds of the patients, but one third was still anosmic after six months treatment. Conclusions: This real-world study shows the effectiveness of the monoclonal antibodies dupilumab and omalizumab in the treatment of severe CRSwNP. Nasal polyp scores and quality-of-life parameters as well as measured olfactory function were improved after just three months. The response after guideline-based criteria was insufficient only in 5 patients of this cohort.
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23
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Chronic Rhinosinusitis, S. aureus Biofilm and Secreted Products, Inflammatory Responses, and Disease Severity. Biomedicines 2022; 10:biomedicines10061362. [PMID: 35740385 PMCID: PMC9220248 DOI: 10.3390/biomedicines10061362] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic rhinosinusitis (CRS) is a persistent inflammation of the nasal cavity and paranasal sinuses associated with tissue remodelling, dysfunction of the sinuses’ natural defence mechanisms, and induction of different inflammatory clusters. The etiopathogenesis of CRS remains elusive, and both environmental factors, such as bacterial biofilms and the host’s general condition, are thought to play a role. Bacterial biofilms have significant clinical relevance due to their potential to cause resistance to antimicrobial therapy and host defenses. Despite substantial medical advances, some CRS patients suffer from recalcitrant disease that is unresponsive to medical and surgical treatments. Those patients often have nasal polyps with tissue eosinophilia, S. aureus-dominant mucosal biofilm, comorbid asthma, and a severely compromised quality of life. This review aims to summarise the contemporary knowledge of inflammatory cells/pathways in CRS, the role of bacterial biofilm, and their impact on the severity of the disease. Here, an emphasis is placed on S. aureus biofilm and its secreted products. A better understanding of these factors might offer important diagnostic and therapeutic perceptions for recalcitrant disease.
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24
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Sedaghat AR, Kuan EC, Scadding GK. Epidemiology of Chronic Rhinosinusitis: Prevalence and Risk Factors. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1395-1403. [PMID: 35092822 DOI: 10.1016/j.jaip.2022.01.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/30/2021] [Accepted: 01/16/2022] [Indexed: 12/16/2022]
Abstract
Knowledge of chronic rhinosinusitis (CRS) epidemiology may directly impact patient care: aiding patient identification and establishing accurate diagnosis as well as informing treatment decisions. The objective of this review is to summarize the current evidence on the epidemiology of CRS, with a focus on prevalence and risk factors. Although the presence of either symptoms or objective findings alone have yielded CRS prevalence estimates of over 10%, the presence of both-consistent with guideline-based diagnostic criteria for CRS-has suggested that the true prevalence of CRS is consistently less than 5%, with approximately one-third of patients with CRS having nasal polyps, in epidemiologic studies from around the world. In comparison, the prevalence of CRS endotypes-pathophysiologic subclassification of CRS most commonly as related to type 2 or non-type 2 inflammation-has been found to vary significantly by region. The epidemiology of CRS is modified and ultimately determined by risk factors: genetic/hereditary, demographic, environmental, and imparted by predictive pre-/comorbid disease. The understanding of these epidemiologic relationships may help the provider to optimally identify and understand each individual's CRS disease process, thereby improving both diagnosis and treatment.
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Affiliation(s)
- Ahmad R Sedaghat
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Edward C Kuan
- Department of Otolaryngology-Head & Neck Surgery, University of California Irvine, Orange, Calif
| | - Glenis K Scadding
- Royal National ENT Hospital, University College Hospitals London, London, United Kingdom; Division of Infection and Immunity, University College London, London, United Kingdom
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25
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Bachert C, Sousa AR, Han JK, Schlosser RJ, Sowerby LJ, Hopkins C, Maspero JF, Smith SG, Kante O, Karidi-Andrioti DE, Mayer B, Chan RH, Yancey SW, Chaker AM. Mepolizumab for chronic rhinosinusitis with nasal polyps: treatment efficacy by comorbidity and blood eosinophil count. J Allergy Clin Immunol 2022; 149:1711-1721.e6. [PMID: 35007624 DOI: 10.1016/j.jaci.2021.10.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/12/2021] [Accepted: 10/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND In the Phase III SYNAPSE study, mepolizumab reduced nasal polyp (NP) size and nasal obstruction in chronic rhinosinusitis with NP (CRSwNP). OBJECTIVE To assess the efficacy of mepolizumab in patients from SYNAPSE grouped by comorbid asthma, aspirin-exacerbated respiratory disease (AERD), and baseline blood eosinophil count (BEC). METHODS SYNAPSE, a randomized, double-blind, 52-week study (NCT03085797), included patients with severe bilateral CRSwNP eligible for surgery despite intranasal corticosteroid treatment. Patients received 4-weekly subcutaneous mepolizumab 100 mg or placebo plus standard of care for 52 weeks. Co-primary endpoints were change in total endoscopic NP score (Week 52) and nasal obstruction visual analog scale (VAS) score (Weeks 49-52). Subgroup analyses by comorbid asthma and AERD status, and post hoc by BEC, were exploratory. RESULTS Analyses included 407 patients (289 with asthma; 108 with AERD; 371 and 278 with BEC counts ≥150 or ≥300 cells/μL, respectively). The proportion of patients with ≥1-point improvement from baseline in NP score was higher with mepolizumab versus placebo across comorbid diseases (asthma: 52.9% vs 29.5%; AERD: 51.1% vs 20.6%) and baseline BEC subgroups (<150 cells/μL: 55.0% vs 31.3%; ≥150 cells/μL: 49.5% vs 28.1%; <300 cells/μL: 50.7% vs 29.0%; ≥300 cells/μL: 50.4% vs 28.1%). A similar trend was observed in patients without comorbid asthma or AERD. More patients had >3-point improvement in nasal obstruction VAS score with mepolizumab versus placebo across comorbid subgroups. CONCLUSION Mepolizumab reduced polyp size and nasal obstruction in CRSwNP regardless of the presence of comorbid asthma or AERD. CLINICAL IMPLICATION Mepolizumab should be considered for the treatment of CRSwNP, particularly in patients with comorbid asthma or AERD.
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Affiliation(s)
- Claus Bachert
- Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University and Ghent University Hospital, Ghent, Belgium; Division of ENT Diseases, CLINTEC, Karolinska Institute, University of Stockholm, Stockholm, Sweden; First Affiliated Hospital, Sun Yat-sen University, International Airway Research Center, Guangzhou, China
| | - Ana R Sousa
- Clinical Sciences, GSK R&D, Brentford, Middlesex, UK
| | - Joseph K Han
- Department of Otolaryngology, Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Claire Hopkins
- ENT Department, Guys and St Thomas's Hospital, and King's College, London, UK
| | - Jorge F Maspero
- Allergy and Respiratory Research Unit, Fundación CIDEA, Buenos Aires, Argentina
| | - Steven G Smith
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, NC, USA
| | - Oliver Kante
- Global Clinical Sciences and Delivery, GSK Munich, Germany
| | | | | | - Robert H Chan
- Clinical Sciences, GSK R&D, Brentford, Middlesex, UK
| | | | - Adam M Chaker
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Otolaryngology and Center for Allergy and Environment, Munich, Germany.
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The relationship between nasal polyps, bronchial asthma, allergic rhinitis, atopic dermatitis, and non-allergic rhinitis. Postepy Dermatol Alergol 2021; 38:650-656. [PMID: 34658709 PMCID: PMC8501437 DOI: 10.5114/ada.2020.94400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 03/25/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Nasal polyps are frequently associated with bronchial asthma and rhinitis. The chronic nature of the symptoms, the high post-treatment recurrence rates, as well as various comorbidities, constitute key factors that significantly affect the quality of life of patients diagnosed with this condition. Aim The purpose of the study was to estimate the prevalence of nasal polyps in the examined population and to assess the possible associative occurrence of nasal polyps (NP) with bronchial asthma (BA), allergic (AR) and non-allergic rhinitis (NAR), and atopic dermatitis (AD). Material and methods The ECRHS II and ISAAC questionnaires of the study group of 18,458 individuals, including 4,473 6–7-year-olds (24.2%), 4,675 13–14-year-olds (25.4%), and 9,310 20–44-year-olds (50.4%) were performed. Results The prevalence of nasal polyps in the examined group was 1.1%, reported by a total of 204 individuals. Nasal polyps were reported more frequently among urban residents (191 (1.1%)) than rural residents (13 (0.6%)). Our study demonstrated a correlation between the presence of nasal polyps and asthma, as well as allergic and non-allergic rhinitis The greatest risk factor for NP in the evaluated subpopulation with multiple allergic conditions was the co-existence of non-allergic rhinitis and atopic dermatitis (OR = 6.09; 95% CI: 3.4–10.93). Conclusions Nasal polyps are relatively rare in the evaluated Polish population. Nonetheless, we believe their co-occurrence with non-allergic rhinitis, allergic rhinitis, bronchial asthma, and atopic dermatitis to be of significant importance, as it illustrates the phenomenon of multimorbidity of inflammatory conditions affecting the upper and lower respiratory tract.
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Beegun I, Koenis DS, Alusi G, Dalli J. Dysregulated Maresin Concentrations in Plasma and Nasal Secretions From Patients With Chronic Rhinosinusitis. Front Immunol 2021; 12:733019. [PMID: 34531873 PMCID: PMC8438229 DOI: 10.3389/fimmu.2021.733019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/09/2021] [Indexed: 01/01/2023] Open
Abstract
The mechanisms that lead to disease onset and propagation in patients with chronic rhinosinusitis (CRS) are not fully elucidated. Maresins (MaR) are a family of essential fatty acid-derived lipid mediators that play a central role in the regulation of inflammation with several studies demonstrating that these mediators display protective activities in airway inflammation. Therefore, in the present studies we evaluated whether concentrations of these mediators were altered in both peripheral blood and nasal secretions from CRS patients. Herein, we focused on patients with CRS that also develop nasal polyps (CRSwNP), given that therapeutic options for the treatment of these patients are limited. Thereby, insights into disease mechanisms in these patients may help design more effective treatments. For this purpose, we compared maresin concentrations from CRSwNP patients with those found in healthy volunteers or patients with an upper respiratory tract infection (URTI), as a self-resolving inflammatory condition. Using liquid chromatography tandem mass spectrometry, we found that MaR concentrations were significantly decreased in plasma from patients with CRSwNP when compared to healthy volunteers. MaR concentrations were observed to be significantly upregulated in nasal secretions from patients with CRSwNP when compared with both healthy volunteers and URTI subjects. Concentration of these mediators in both plasma and nasal secretions from CRSwNP patients were positively correlated with quality-of-life scores in these patients. Assessment of the concentrations of other pro-resolving and pro-inflammatory lipid mediators (LM) demonstrated that there was a general shift in LM levels in both plasma and nasal secretions from CRSwNP when compared with healthy volunteers and URTI subjects. Of note, incubation of peripheral blood cells from CRSwNP patients with MaR1 downregulated the expression of activation markers on peripheral blood phagocytes, including CD41 and CD62P, markers of platelet-leukocyte heterotypic aggregates. Together these findings demonstrate that both local and systemic LM concentrations, in particularly those of the MaR family, become altered in patients with CRSwNP. They also suggest that therapeutics designed around MaR1 may be useful in regulating the activation of phagocytes in patients with CRSwNP thereby potentially also limiting the local inflammatory response in these patients.
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Affiliation(s)
- Issa Beegun
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Duco S Koenis
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Ghassan Alusi
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Jesmond Dalli
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Centre for Inflammation and Therapeutic Innovation, Queen Mary University of London, London, United Kingdom
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Comparative efficacy and safety of monoclonal antibodies and aspirin desensitization for chronic rhinosinusitis with nasal polyposis: A systematic review and network meta-analysis. J Allergy Clin Immunol 2021; 149:1286-1295. [PMID: 34543652 DOI: 10.1016/j.jaci.2021.09.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/25/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory condition of the upper airways. Optimal management is unclear. OBJECTIVE We compared the effects of mAbs and aspirin desensitization (ASA-D) for treatment of CRSwNP. METHODS We searched the Medline, Embase, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform, US Food and Drug Administration, and the European Medicines Agency databases from inception to August 4, 2021, for randomized controlled trials comparing the effects of mAbs and ASA-D for CRSwNP. We conducted network meta-analysis of sinusitis symptoms, heath-related quality of life, rescue oral corticosteroids and surgery, endoscopic and radiologic scores, and adverse events. We used the Grades of Recommendation Assessment, Development and Evaluation (GRADE) approach to assess certainty of evidence. PROSPERO CRD42020177334. RESULTS Twenty-nine randomized controlled trials evaluating 8 treatments (n = 3461) were included in the network meta-analysis. Compared to placebo, moderate to high certainty evidence showed that health-related quality of life (SNOT-22) improved with dupilumab (mean difference [MD] -19.91 [95% confidence interval (CI) -22.50, -17.32]), omalizumab (MD -16.09 [95% CI -19.88, -12.30]), mepolizumab (MD -12.89 [95% CI -16.58, -9.19], ASA-D (MD -10.61 [95% CI -14.51, -6.71]), and benralizumab (MD -7.68 [95% CI -12.09, -3.27]). The risk of rescue nasal polyp surgery likely decreased with dupilumab (risk difference [RD] -16.35% [95% CI -18.13, -13.48]), omalizumab (RD -7.40% [95% CI -11.04, -2.43]), mepolizumab (RD -12.33% [95% CI -15.56, -7.22]), and ASA-D (RD -16.00% [95% CI -19.79, 0.21]; all moderate certainty). Comparisons among agents show with moderate to high certainty that dupilumab ranks among the most beneficial for 7 of 7 outcomes, omalizumab for 2 of 7, mepolizumab for 1 of 7, and ASA-D for 1 of 7. CONCLUSIONS Multiple biologics and ASA-D credibly improve patient-important outcomes, with clinically important differences in effects among agents; dupilumab uniquely ranks among the most beneficial for all outcomes studied.
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Long-term efficacy and safety of omalizumab for nasal polyposis in an open-label extension study. J Allergy Clin Immunol 2021; 149:957-965.e3. [PMID: 34530020 DOI: 10.1016/j.jaci.2021.07.045] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/16/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) frequently remains uncontrolled despite maximal medical therapy and sinonasal surgery, presenting several unmet needs and challenges. Omalizumab previously demonstrated efficacy in CRSwNP in duplicate phase 3, randomized, placebo-controlled trials (POLYP 1, POLYP 2). OBJECTIVE This open-label extension evaluated the continued efficacy, safety, and durability of response of omalizumab in adults with CRSwNP who completed POLYP 1 or 2. METHODS After 24 weeks of omalizumab or placebo in POLYP 1 and 2, patients (n = 249) received open-label omalizumab plus background nasal mometasone therapy for 28 weeks and were subsequently followed for 24 weeks after omalizumab discontinuation. Efficacy end points assessed change from baseline for the coprimary end points, Nasal Polyp Score and Nasal Congestion Score, and the secondary end points of Sino-Nasal Outcome Test 22, Total Nasal Symptom Score and its components, and University of Pennsylvania Smell Identification Test scores. Safety objectives included incidence of adverse events and adverse events leading to omalizumab discontinuation. RESULTS Patients who continued omalizumab experienced further improvements across coprimary end points and secondary end points through 52 weeks. Patients who switched from placebo to omalizumab experienced favorable responses across end points through week 52 that were similar to POLYP 1 and 2 at week 24. After omalizumab discontinuation, scores gradually worsened over the 24-week follow-up, but remained improved from pretreatment levels for both groups. The safety profile was similar to previous reports. CONCLUSIONS The efficacy and safety profile from this study supports extended omalizumab treatment up to 1 year for CRSwNP with inadequate response to nasal corticosteroids.
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Raciborski F, Arcimowicz M, Samoliñski B, Pinkas W, Samel-Kowalik P, Śliwczyñski A. Recorded prevalence of nasal polyps increases with age. Postepy Dermatol Alergol 2021; 38:682-688. [PMID: 34658713 PMCID: PMC8501424 DOI: 10.5114/ada.2020.99365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/14/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Nasal polyps are a multifactorial inflammatory condition of the upper airways. Nasal polyps typically affect middle-aged and elderly patients, average age at diagnosis is 40 to 60, and men are affected more commonly than women. AIM To analyse the reported prevalence of nasal polyps in the Polish population, including demographics and co-morbidities, and to estimate the costs of outpatient and hospital (inpatient) services financed by the National Health Fund. MATERIAL AND METHODS Statistical analysis of data extracted from the National Health Fund (NHF) registers for 2008-2018. RESULTS In 2018, the recorded prevalence of nasal polyps in Poland was 52.0/10,000 population (0.52%), amounting to 64.6/10,000 (0.65%) in men and 40.2/10,000 (0.40) in women. Nasal polyps were much more frequent in patients aged 55-59 (98.1/10000) and 75-79 years (98.7/10,000). Among men, the highest prevalence was found in the 75-79 age group (164.3/10,000 population), and among women in the 55-59 age group (75.1/10,000). In 2018, the Polish NHF spent PLN 17.2 million (equivalent to EUR 4.0 million/USD 4.7 million) on health services related to the diagnosis of nasal polyps. Hospital services accounted for 77.4% of the total cost. CONCLUSIONS Nasal polyps are more than one and a half times as prevalent in men than in women. The recorded prevalence of nasal polyps increases with age, with the rates peaking in those between 75 and 79 years old, and is more often in urban than rural areas.
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Affiliation(s)
- Filip Raciborski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Arcimowicz
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Bolesław Samoliñski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Pinkas
- Department of Otolaryngology, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Piotr Samel-Kowalik
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Śliwczyñski
- National Health Fund, Warsaw, Poland
- Satellite Campus in Warsaw, University of Humanities and Economics in Lodz, Poland
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Feng T, Miao P, Liu B, Liu Y, Bao X, Xu J, Ren N, Li Y, Shi J, Cao W, Fang J, Li M, Liu Q, Li J. Sinus Microbiota in Patients With Eosinophilic and Non-Eosinophilic Chronic Rhinosinusitis With Nasal Polyps. Front Cell Infect Microbiol 2021; 11:672355. [PMID: 34368010 PMCID: PMC8346020 DOI: 10.3389/fcimb.2021.672355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/04/2021] [Indexed: 12/15/2022] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by Th2-skewed inflammation and increased colonization by Staphylococcus aureus. CRSwNP can be distinguished as eosinophilic (ECRSwNP) and non-eosinophilic (NECRSwNP) by the infiltration of eosinophils. The local microbiota plays an important role in the persistent inflammation of CRSwNP. To evaluate the bacterial community composition on the distinct types of CRSwNP patients, we collected nasal swabs from 16 ECRSwNP patients, 18 NECRSwNP patients, and 39 healthy control subjects. The microbiome structure for all the samples were analyzed by high-throughput 16S rRNA gene sequencing. Concentration of S. aureus was determined using TaqMan quantitative polymerase chain reaction (qPCR) targeting the nuclease (nuc) gene. The result showed significant differences in the sinus microbiome among healthy control subjects and CRSwNP patients. Microbiota community diversity was significantly lower in NECRSwNP samples compared to that of healthy control subjects. Interestingly, the abundance of several pathogenic bacteria was diverse between ECRSwNP and NECRSwNP patients. Although Staphylococcus prevailed in all groups, the abundance of Staphylococcus was significantly higher in the healthy control group than the ECRSwNP group. More importantly, the abundance of S. aureus was much higher in NECRSwNP patients. This study highlights that microbiota composition may contribute to the different clinical types of CRSwNP, inspiring new therapeutic strategies to resolve this chronic inflammation process.
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Affiliation(s)
- Tingting Feng
- Department of Otorhinolaryngology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ping Miao
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bin Liu
- Department of Otorhinolaryngology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yao Liu
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ximing Bao
- Department of Otorhinolaryngology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ji Xu
- Department of Otorhinolaryngology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Nana Ren
- Department of Otorhinolaryngology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ying Li
- Department of Otorhinolaryngology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiali Shi
- Department of Otorhinolaryngology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wanxin Cao
- Department of Otorhinolaryngology, Peking University Third Hospital, Peking University, Beijing, China
| | - Jianchen Fang
- Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Min Li
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qian Liu
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiping Li
- Department of Otorhinolaryngology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Campion NJ, Kohler R, Ristl R, Villazala-Merino S, Eckl-Dorna J, Niederberger-Leppin V. Prevalence and Symptom Burden of Nasal Polyps in a Large Austrian Population. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:4117-4129.e2. [PMID: 34265447 DOI: 10.1016/j.jaip.2021.06.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory condition with significant morbidity and financial cost, information regarding prevalence and disease burden of this condition is scarce. OBJECTIVE In this study we determined nasal polyp prevalence, polyp grade, concomitant disease, and symptom burden in > 10,000 central European subjects. METHODS In this retrospective, cross-sectional study, 10,259 patients who had undergone routine examination of their nose by nasal endoscopy during a visit at a publicly accessible ENT outpatient facility in Vienna were included. Patient details including presenting complaint, nasal symptoms, polyp score, age, gender, treatment, asthma and allergic status were extracted retrospectively. A detailed questionnaire including history of nasal symptoms, SNOT-20 GAV, and VAS was available for 101 patients with nasal polyps. RESULTS Nasal polyps were detected in 189 (1.84%) of the 10,259 patients. The calculated prevalence of polyps in Austria, adjusted for age and gender, was 1.95%. The average TPS was 3.4, 72.5% had a TPS of ≤4, with males and asthmatics having significantly larger polyps. Questionnaire analysis revealed that 67% suffered from a low symptom burden of ≤36. According to current EPOS guidelines, 6% of polyp patients fulfilled and another 8% potentially fulfil the eligibility criteria for biological therapy. CONCLUSION Nasal polyp prevalence was calculated to be 1.95% of the Austrian population. Large polyps (TPS>4) were found in 25%, 33% suffered from a high nasal symptom burden, and between 6 to 14% of polyp patients would be eligible for biological therapy according to EPOS guidelines.
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Affiliation(s)
| | - Rebecca Kohler
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Robin Ristl
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | | | - Julia Eckl-Dorna
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria.
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Dobretsov KG, Kolenchukova O, Sipkin A, Bellussi LM, Ciprandi G, Passali D. A randomized, double-blind, placebo- -controlled study to investigate the use of bacteriophages in patients with chronic rhinosinusitis with nasal polyps. Otolaryngol Pol 2021; 75:33-37. [PMID: 35175218 DOI: 10.5604/01.3001.0015.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background A randomized, double-blind placebo-controlled study investigated the use of bacteriophages in the treatment of chronic rhinosinusitis with nasal polyps. Materials and Methods 40 adult patients with сhronic rhinosinusitis with nasal polyps were examined. All patients underwent functional endoscopic sinus surgery. After the surgery, 20 patients got the intranasal gel with a bacteriophages mixture (Otofag, Micromir, Russia) twice a day for ten weeks, and 20 patients got a placebo. Results On the 10th day, IL-1β secretion diminished (63 mg/ml versus 440 mg/ml in control). There was a decrease in the total number of microorganisms and Enterobacteriaceae (5.7 x 106 CFU/ml versus 1.2 x 109 CFU/ml in control), and the absence of Streptococci (versus 2.1 x 109 CFU/ml in control) on the 30th day of the treatment in the group with the bacteriophages. On the 10th day, a decrease in the activity of secretory IL-1β and IL-8 strongly and very strongly correlated with a total number of microorganisms (r = 0.7; r = 0.9 respectively), as well as secretory IL-8 with Enterobacteriaceae (r = 0.72) and Staphylococci (r = 0.65) in the active group treated with the bacteriophages. On the 30th day, the decrease in serum IL-1β significantly correlated with the total number of microorganisms (r = 0.80) and enterobacteria (r = 0.90) in the active group. Conclusions The administration of bacteriophages restored the balance of microorganisms in the nasal cavity and decreased the inflammatory response in chronic rhinosinusitis with nasal polyps. These changes, such as an inflammation dampening, could theoretically reduce the recurrent growth of polyp tissue in the future.
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Affiliation(s)
| | - Oxana Kolenchukova
- Federal Siberian Scientific and Clinical Center of Federal Medical-Biological Agency of Russia, Krasnoyarsk, Russia
| | - Alexander Sipkin
- Federal Research Center "Krasnoyarskii Scientific Center" of the Siberian branch of the Russian Academy of Sciences, Scientific Research Institute of Medical Problems of the North, Russia
| | | | - Giorgio Ciprandi
- Outpatients Clinics Dept., Casa di Cura Villa Montallegro, Genoa, Italy
| | - Desiderio Passali
- IFOS, International Federation of Otorhinolaryngological Societies, Rome, Italy
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Fokkens W, Van Der Lans R, Reitsma S. Dupilumab for the treatment of chronic rhinosinusitis with nasal polyposis. Expert Opin Biol Ther 2021; 21:575-585. [PMID: 33724109 DOI: 10.1080/14712598.2021.1901881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) affects 1-2.5% of the population and is associated with significant adverse effects on quality of life (QoL). CRSwNP is strongly correlated with (late onset) asthma with 30-70% of the CRSwNP patients having asthma. Health-care spending in rhinosinusitis is high, especially because of indirect costs.Areas covered: In the last years, the recognition of endotyping as an essential presumption to precision medicine has significantly changed the integrated care pathways in the treatment of chronic rhinosinusitis. Dupilumab is the first biological available for the treatment of CRswNP, since late 2019. Treatment with dupilumab results in a significant improvement of QoL (measured as SNOT-22), rhinosinusitis disease severity, symptoms of rhinosinusitis, and especially sense of smell, nasal polyp score, Lund-Mackay CT score, and asthma outcomes (ACQ5 and FEV1) compared to placebo.Expert opinion: At this moment, the high cost of the treatment requires careful patient selection and within the EUFOREA and EPOS2020 context, experts have tried to give guidance based on today's data. We now need trials evaluating which patients benefit most from treatment with biologicals and in which patients the treatment is cost-effective.
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Affiliation(s)
- Wytske Fokkens
- Otolaryngologist, Epidemiologist, Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, North Holland, AZ, Netherlands
| | - Rik Van Der Lans
- Otolaryngologist, Epidemiologist, Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, North Holland, AZ, Netherlands
| | - Sietze Reitsma
- Otolaryngologist, Epidemiologist, Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, North Holland, AZ, Netherlands
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Bachert C, Maurer M, Palomares O, Busse WW. What is the contribution of IgE to nasal polyposis? J Allergy Clin Immunol 2021; 147:1997-2008. [PMID: 33757720 DOI: 10.1016/j.jaci.2021.03.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/10/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023]
Abstract
Taking a novel approach, this narrative review collates knowledge about nasal polyposis and the biological functions of IgE in several diseases (allergic rhinitis, allergic asthma, nonsteroidal anti-inflammatory drugs-exacerbated respiratory disease, and chronic spontaneous urticaria) to consider which IgE-mediated mechanisms are relevant to nasal polyposis pathology. A type 2 eosinophil-dominated inflammatory signature is typical in nasal polyp tissue of European patients with nasal polyposis, with a shift toward this endotype observed in Asian populations in recent years. Elevated polyclonal IgE is present in the nasal tissue of patients with and without allergy. It is derived from many different B-cell clones and, importantly, is functional (proinflammatory). Staphylococcus aureus enterotoxins are thought to act as superantigens, inducing production of polyclonal IgE via B-cell and T-cell activation, and triggering release of inflammatory mediators. In some patients, exposure to antigens/triggers leads to production of high levels of antigen-specific IgE, which mediates cross-linking of the high-affinity IgE receptor on various cells, causing release of inflammatory mediators. The efficacy of omalizumab confirms IgE as an important inflammatory mediator in nasal polyposis. By blocking IgE, omalizumab targets the T2 inflammation in nasal polyposis, reduces nasal polyp score and improves symptoms.
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Affiliation(s)
- Claus Bachert
- Upper Airways Research Laboratory, Ghent University, Ghent, Belgium; Division of ENT Diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden.
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain
| | - William W Busse
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 357] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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Yu J, Xian M, Piao Y, Zhang L, Wang C. Changes in Clinical and Histological Characteristics of Nasal Polyps in Northern China over the Past 2-3 Decades. Int Arch Allergy Immunol 2021; 182:615-624. [PMID: 33596581 DOI: 10.1159/000513312] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Recent studies have shown that inflammatory patterns of nasal polyps from patients with chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) in East Asia have changed over time. However, to date there is a marked lack of similar data for CRSwNP in Northern China. This study thus aimed to assess the changes in the clinical and histological characteristics of CRSwNP patients from Northern China over the past 2-3 decades. METHODS This was a retrospective study, which examined data from 2 groups of 150 CRSwNP patients each, who had undergone endoscopic sinus surgery in Beijing Tongren Hospital from 1993 to 1995 (group A) and from 2015 to 2019 (group B). All relevant data for demographic, clinical, and histological parameters were collected for each patient from the 2 groups and compared for overall changes between the 2 groups. RESULTS The comorbidity of CRSwNP and asthma increased over time and the cellular phenotype of CRSwNPchanged significantly; in particular, the proportion of eosinophil-dominant CRSwNP increased, lymphocyte-dominant and plasma-dominant CRSwNP decreased significantly, and the proportions of neutrophil-dominant and mixed CRSwNP were not altered. The rate of polyp recurrence increased in CRSwNP but did not in eosinophilic CRSwNP. Smoking and age did not significantly impact the inflammatory patterns of CRSwNP. CONCLUSIONS The inflammatory patterns of CRSwNP patients have changed and comorbidity of asthma significantly increased in CRSwNP patients in Northern China over the past 2-3 decades.
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Affiliation(s)
- Jiaqi Yu
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Mu Xian
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Yingshi Piao
- Department of Pathology, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China, .,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China, .,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China, .,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China,
| | - Chengshuo Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
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Bachert C, Bhattacharyya N, Desrosiers M, Khan AH. Burden of Disease in Chronic Rhinosinusitis with Nasal Polyps. J Asthma Allergy 2021; 14:127-134. [PMID: 33603409 PMCID: PMC7886239 DOI: 10.2147/jaa.s290424] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/24/2020] [Indexed: 01/05/2023] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a predominantly type 2 inflammation-mediated disease of the nasal mucosa and paranasal sinuses with an under-recognized clinical, humanistic, and economic burden. Patients with CRSwNP experience a high symptom burden, including nasal congestion, loss of smell, and rhinorrhea, which has a negative impact on physical and mental health-related quality of life, including sleep quality. Existing medical and surgical interventions, including local and systemic corticosteroids and endoscopic sinus surgery, may be associated with recurrence of nasal polyps and associated symptoms and with an increased risk of short- and long-term adverse effects, especially with repeated or long-term use. Because type 2 inflammation is implicated in the pathogenesis of several coexisting diseases, patients with CRSwNP often have comorbid asthma and/or nonsteroidal anti-inflammatory drug-exacerbated respiratory disease. These patients, as well as those with high corticosteroid use and/or sinonasal surgical history, have more severe disease and associated symptom burden and represent a difficult-to-treat population under the existing management paradigm. This article reviews the clinical, humanistic, and economic burden of CRSwNP; it highlights the unmet need for effective and safe CRSwNP therapies that effectively control symptoms and minimize recurrence by targeting the underlying type 2 inflammatory disease pathophysiology.
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Affiliation(s)
- Claus Bachert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium.,CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | | | - Martin Desrosiers
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Asif H Khan
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium.,Sanofi, Chilly-Mazarin, France
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Eosinophils in the Field of Nasal Polyposis: Towards a Better Understanding of Biologic Therapies. Clin Rev Allergy Immunol 2021; 62:90-102. [DOI: 10.1007/s12016-021-08844-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 12/15/2022]
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40
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Bartier S, Coste A, Béquignon E. Biotherapy and treatment of adult primary chronic rhinosinusitis with nasal polyps: Cellular and molecular bases. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:355-362. [PMID: 33358657 DOI: 10.1016/j.anorl.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The present article reviews the molecular and cellular mechanisms involved in the pathophysiology of chronic rhinosinusitis with nasal polyps (CRSwCRSwNP) and underlying the action mechanisms of biotherapies. Biotherapy uses substances naturally produced by the organism or their specific antagonists targeting a proinflammatory mechanism. CRSwCRSwNP is a form of chronic rhinosinusitis (CRS), which is classically subdivided in to 2 types according to the presence of polyps. In recent years, the concept of endotypes emerged, with a more exhaustive definition of the types of CRS according to inflammatory mechanism, with a view to developing personalized treatments. CRSwNP pathophysiology is poorly understood. Polyps arise from a primary epithelial lesion in a context of chronic local inflammation, mainly type 2 in Europe, implicating eosinophils, IgE, Th2 cytokines (IL-4/IL-13, IL-5) and T and B cells. Biotherapy seems promising in CRSwNP. The present review details the various pathophysiological pathways underlying the action mechanisms of biotherapies, and the various published studies, assessing efficacy and mode of action in the treatment of CRSwNP.
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Affiliation(s)
- S Bartier
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France; Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital Henri Mondor, 94000 Créteil, France; Université Paris-Est Créteil (UPEC), Faculté de Médecine, 94000 Créteil, France; INSERM U955, 94000 Créteil, France; CNRS, ERL 7240, 94000 Créteil, France.
| | - A Coste
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France; Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital Henri Mondor, 94000 Créteil, France; Université Paris-Est Créteil (UPEC), Faculté de Médecine, 94000 Créteil, France; INSERM U955, 94000 Créteil, France; CNRS, ERL 7240, 94000 Créteil, France
| | - E Béquignon
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France; Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital Henri Mondor, 94000 Créteil, France; Université Paris-Est Créteil (UPEC), Faculté de Médecine, 94000 Créteil, France; INSERM U955, 94000 Créteil, France; CNRS, ERL 7240, 94000 Créteil, France
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Laidlaw TM, Mullol J, Woessner KM, Amin N, Mannent LP. Chronic Rhinosinusitis with Nasal Polyps and Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1133-1141. [PMID: 33065369 DOI: 10.1016/j.jaip.2020.09.063] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 01/14/2023]
Abstract
Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) characterized by a type 2 immune signature often have severe and recurrent disease. Lower airway conditions such as asthma are common comorbidities and share similar pathophysiology. CRSwNP with asthma is characterized by tissue eosinophilia and high local IgE levels. Clinically, CRSwNP with comorbid asthma is associated with more severe sinonasal symptoms and worse quality of life, and it is more difficult to treat both medically and surgically. Asthma in the presence of nasal polyposis is also more difficult to control, being more exacerbation prone, with increased airway obstruction and more extensive eosinophilic inflammation. Aspirin/nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (AERD) is a recognized phenotype of CRSwNP with comorbid asthma. Patients with CRSwNP with comorbid AERD are among those with the most severe and difficult-to-treat disease, and tend to have severe NP. The shared pathophysiology of the upper and lower airways has important implications for both the diagnosis and management of respiratory comorbidities. However, in clinical practice, the nose and lungs are often treated as separate entities. The underlying systemic inflammatory link between CRSwNP and asthma provides a compelling rationale for systemic treatment with novel biologics targeting shared underlying type 2 inflammatory pathways.
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Affiliation(s)
- Tanya M Laidlaw
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
| | - Joaquim Mullol
- Hospital Clínic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | - Katharine M Woessner
- Division of Allergy, Asthma and Immunology, Scripps Medical Clinic Group, San Diego, Calif
| | - Nikhil Amin
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
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KC B, Khan GM, Shrestha N. Nasal Spray Use Technique Among Patients Attending the Out-Patient Department of a Tertiary Care Hospital, Gandaki Province, Nepal. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2020; 9:155-160. [PMID: 33062617 PMCID: PMC7519804 DOI: 10.2147/iprp.s266191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/02/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Nasal sprays are used to deliver the medications locally to the nasal cavity. The majority of patients have been observed to perform nasal spray use techniques inadequately. This study was conducted to evaluate the impact of the intervention on nasal spray use technique. METHODS This was a prospective pre- and post-interventional study to evaluate the nasal spray use technique among the subjects with the help of nasal spray checklist. A standardized WHO nasal spray checklist was used on the study conducted in Manipal Teaching Hospital, Pokhara, Nepal from July to October 2019. Subjects were asked to demonstrate the technique and a scoring system was applied before and after the intervention by the researcher. The total score of the intervention technique ranges from 0 to 11. After evaluation of the technique at the first visit, subjects were provided with an informative leaflet having all the steps to be followed to use the spray and the technique was re-evaluated after 10 days. RESULTS A total of 81 subjects (51.9% male and 48.1% female) participated in the study. The average duration of nasal drug use was 15 days. The overall mean±SD score was 4.31±1.625 before intervention and 9.84±1.699 after intervention. After the intervention, the percentage of subjects using the nasal spray correctly increased by 50.27%. Wilcoxon signedrank test showed intervention on nasal spray use technique was effective (p=0.0001). CONCLUSION The nasal spray use technique was poor among the subjects before the intervention. The intervention was substantially effective in improving the technique to use the nasal spray. Regular assessment and reinforcement of correct technique by health professionals will improve the proper use technique of nasal spray, hence increasing the effectiveness of the therapy.
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Affiliation(s)
- Binita KC
- School of Health and Allied Sciences, Pokhara University, Kaski, Nepal
| | | | - Niranjan Shrestha
- School of Health and Allied Sciences, Pokhara University, Kaski, Nepal
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Zhong B, Yuan T, Du J, Tan K, Yang Q, Liu F, Liu Y, Ba L, Liu S. The role of preoperative blood eosinophil counts in distinguishing chronic rhinosinusitis with nasal polyps phenotypes. Int Forum Allergy Rhinol 2020; 11:16-23. [PMID: 32634298 DOI: 10.1002/alr.22636] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common heterogenous disease in the patients with chronic airway diseases. This study investigated the role of blood eosinophil count (BEC) in the classification of CRSwNP and its recurrence in eosinophilic CRSwNP. METHODS Sixty-five patients who underwent nasal endoscopic resection of CRSwNP were recruited and divided into eosinophilic CRSwNP and non-eosinophilic CRSwNP groups based on the levels (10% cutoff) of eosinophil infiltration as indicated by hematoxylin and eosin (H&E) staining. RESULTS We recruited 30 patients in the eosinophilic CRSwNP group and 35 patients in the non-eosinophilic CRSwNP group. The outcome of preoperative visual analogue scale (VAS) score, preoperative Lund-Mackay score, and preoperative Lund-Kennedy score between the 2 groups were comparable. The level of BEC in the eosinophilic CRSwNP group was significantly higher than that of non-eosinophilic CRSwNP group (0.79 ± 0.27 × 109 /L vs 0.30 ± 0.22 × 109 /L; p < 0.001). We observed a statistical significance in the number of H&E eosinophils (29.11 ± 2.93 vs 3.17 ± 0.51; p < 0.001) and CRSwNP phenotypes (eosinophilic/non-eosinophilic, 28/3 vs 2/32; p < 0.001) when the cutoff value of BEC was set at 0.39 × 109 /L. The disease-free recurrence (DFR) was found to be statistically significant when the cutoff value of BEC was 0.73 × 109 /L in eosinophilic CRSwNP (p = 0.009). CONCLUSION Results indicate that BEC may be capable of distinguishing CRSwNP phenotypes as well as predicting polyp recurrence in eosinophilic CRSwNP. Given the relatively small sample size, further studies will be necessary to confirm a role for BEC as a systemic biomarker in CRSwNP.
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Affiliation(s)
- Bing Zhong
- Upper Airways Research Laboratory, Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tian Yuan
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun, Yat-Sen University, Guangzhou, Guangdong, China
| | - Jintao Du
- Upper Airways Research Laboratory, Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaisen Tan
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Qintai Yang
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun, Yat-Sen University, Guangzhou, Guangdong, China
| | - Feng Liu
- Upper Airways Research Laboratory, Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yafeng Liu
- Upper Airways Research Laboratory, Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Luo Ba
- Department of Otolaryngology, People's Hospital of Tibet Autonomous Region, Lhasa, Tibet, China
| | - Shixi Liu
- Upper Airways Research Laboratory, Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Ryu G, Min C, Park B, Choi HG, Mo JH. Bidirectional association between asthma and chronic rhinosinusitis: Two longitudinal follow-up studies using a national sample cohort. Sci Rep 2020; 10:9589. [PMID: 32533009 PMCID: PMC7293248 DOI: 10.1038/s41598-020-66479-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 05/20/2020] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to evaluate an epidemiologic association of asthma and chronic rhinosinusitis (CRS) using a national sample cohort of the Korean population. We collected data from the Korean Health Insurance Review and Assessment Service-National Sample Cohort between 2002 and 2013, and two different case-control cohorts were designed (1st: asthmatic patients matched in a 1:1 ratio with 204,119 non-asthmatics as control I, 2nd: CRS patients matched in a 1:4 ratio with 124,020 non-CRS patients as control II). Bidirectional association was examined using Cox proportional hazard models stratified by age, sex, income, and region of residence. Patients with asthma had an increased risk of developing CRS [adjusted hazard ratio (95% confidence interval) = 1.74 (1.67–1.80)], both with nasal polyps [1.55 (1.36–1.78)], without nasal polyps [1.74 (1.67–1.81)]. In the second cohort, patients with CRS had increased risk of developing asthma [1.85 (1.80–1.91)] with similar results for those with and without nasal polyps. The strongest association for risk of CRS was in 20–39 years old men with asthma [2.41 (1.97–2.96)], while the strongest association for increased risk of asthma in those with CRS group was also seen in this same subgroup [2.40 (2.18–2.63)]. CRS and asthma had a bidirectional influence on each other. CRS increased the risk of asthma, and asthma increased the risk of CRS, especially in young men.
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Affiliation(s)
- Gwanghui Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Chanyang Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Republic of Korea.,Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Bumjung Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Republic of Korea.
| | - Ji-Hun Mo
- Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan, Republic of Korea. .,Beckman Laser Institute Korea, Dankook University College of Medicine, Cheonan, Republic of Korea.
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Naclerio R, Baroody F, Bachert C, Bleier B, Borish L, Brittain E, Chupp G, Fisher A, Fokkens W, Gevaert P, Kennedy D, Kim J, Laidlaw TM, Lee JJ, Piccirillo JF, Pinto JM, Roland LT, Schleimer RP, Schlosser RJ, Schwaninger JM, Smith TL, Tan BK, Tan M, Toskala E, Wenzel S, Togias A. Clinical Research Needs for the Management of Chronic Rhinosinusitis with Nasal Polyps in the New Era of Biologics: A National Institute of Allergy and Infectious Diseases Workshop. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:1532-1549.e1. [PMID: 32142964 PMCID: PMC8177483 DOI: 10.1016/j.jaip.2020.02.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 12/11/2022]
Abstract
The development of biologics targeting various aspects of type 2 inflammation for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) will provide clinicians with powerful tools to help treat these patients. However, other therapies are also available, and positioning of biologics in a management algorithm will require comparative trials. In November 2019, the National Institute of Allergy and Infectious Diseases convened a workshop to consider potential future trial designs. Workshop participants represented a wide spectrum of clinical specialties, including otolaryngology, allergy, and pulmonary medicine, as well as expertise in CRSwNP pathophysiology and in trial methodology and statistics. The workshop discussed the current state of knowledge in CRSwNP and considered the advantages and disadvantages of various clinical trial or observational study designs and various clinical outcomes. The output from this workshop, which is presented in this report, will hopefully provide investigators with adequate information and ideas to design future studies and answer critical clinical questions. It will also help clinicians understand the current state of the management of CRSwNP and its gaps and be more able to interpret the new information to come.
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Affiliation(s)
| | | | | | - Benjamin Bleier
- Harvard Medical School, Massachusetts Eye and Ear, Department of Otolaryngology, Boston, Mass
| | | | - Erica Brittain
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | | | - Anat Fisher
- University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Jean Kim
- Johns Hopkins University, Baltimore, Md
| | - Tanya M Laidlaw
- Harvard Medical School, Brigham and Women's Hospital, Division of Allergy and Clinical Immunology, Boston, Mass
| | | | | | | | - Lauren T Roland
- University of California-San Francisco, San Francisco, Calif
| | | | | | - Julie M Schwaninger
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | | | | | - Ming Tan
- Georgetown University, Washington, DC
| | | | | | - Alkis Togias
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.
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Liu Z, Chen J, Cheng L, Li H, Liu S, Lou H, Shi J, Sun Y, Wang D, Wang C, Wang X, Wei Y, Wen W, Yang P, Yang Q, Zhang G, Zhang Y, Zhao C, Zhu D, Zhu L, Chen F, Dong Y, Fu Q, Li J, Li Y, Liu C, Liu F, Lu M, Meng Y, Sha J, She W, Shi L, Wang K, Xue J, Yang L, Yin M, Zhang L, Zheng M, Zhou B, Zhang L. Chinese Society of Allergy and Chinese Society of Otorhinolaryngology-Head and Neck Surgery Guideline for Chronic Rhinosinusitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:176-237. [PMID: 32009319 PMCID: PMC6997287 DOI: 10.4168/aair.2020.12.2.176] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/05/2019] [Accepted: 11/13/2019] [Indexed: 02/05/2023]
Abstract
The current document is based on a consensus reached by a panel of experts from the Chinese Society of Allergy and the Chinese Society of Otorhinolaryngology-Head and Neck Surgery, Rhinology Group. Chronic rhinosinusitis (CRS) affects approximately 8% of Chinese adults. The inflammatory and remodeling mechanisms of CRS in the Chinese population differ from those observed in the populations of European descent. Recently, precision medicine has been used to treat inflammation by targeting key biomarkers that are involved in the process. However, there are no CRS guidelines or a consensus available from China that can be shared with the international academia. The guidelines presented in this paper cover the epidemiology, economic burden, genetics and epigenetics, mechanisms, phenotypes and endotypes, diagnosis and differential diagnosis, management, and the current status of CRS in China. These guidelines-with a focus on China-will improve the abilities of clinical and medical staff during the treatment of CRS. Additionally, they will help international agencies in improving the verification of CRS endotypes, mapping of eosinophilic shifts, the identification of suitable biomarkers for endotyping, and predicting responses to therapies. In conclusion, these guidelines will help select therapies, such as pharmacotherapy, surgical approaches and innovative biotherapeutics, which are tailored to each of the individual CRS endotypes.
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Affiliation(s)
- Zheng Liu
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianjun Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Cheng
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
- International Centre for Allergy Research, Nanjing Medical University, Nanjing, China
| | - Huabin Li
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Shixi Liu
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongfei Lou
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Jianbo Shi
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Sun
- Department of Immunology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Dehui Wang
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Xiangdong Wang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Yongxiang Wei
- Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Weiping Wen
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Hospital, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pingchang Yang
- Research Center of Allergy & Immunology, Shenzhen University School of Medicine, Shenzhen, China
| | - Qintai Yang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Gehua Zhang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Changqing Zhao
- Department of Otolaryngology Head and Neck Surgery, The Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Dongdong Zhu
- Department of Otolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Li Zhu
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing, China
| | - Fenghong Chen
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Dong
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Qingling Fu
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingyun Li
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Yanqing Li
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Chengyao Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Feng Liu
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Meiping Lu
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Yifan Meng
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Jichao Sha
- Department of Otolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wenyu She
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lili Shi
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kuiji Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Jinmei Xue
- Department of Otolaryngology Head and Neck Surgery, The Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Luoying Yang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Min Yin
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
- International Centre for Allergy Research, Nanjing Medical University, Nanjing, China
| | - Lichuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ming Zheng
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Bing Zhou
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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47
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Hamada K, Oishi K, Chikumoto A, Murakawa K, Ohteru Y, Matsuda K, Uehara S, Suetake R, Ohata S, Murata Y, Yamaji Y, Asami-Noyama M, Ito K, Edakuni N, Hirano T, Matsunaga K. Impact of sinus surgery on type 2 airway and systemic inflammation in asthma. J Asthma 2020; 58:750-758. [PMID: 32050820 DOI: 10.1080/02770903.2020.1729380] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective: Asthma is frequently associated with chronic rhinosinusitis with nasal polyps (CRSwNP). Although endoscopic sinus surgery (ESS) improves asthma control in CRSwNP patients with asthma, the mechanism that underlies the response to surgical treatment is still unclear. We evaluated the relevance of changes in asthma control and changes in airway/systemic inflammation in eosinophilic CRSwNP patients with not well controlled asthma who underwent ESS.Methods: We prospectively assessed changes in the asthma control questionnaire (ACQ) score, blood eosinophil counts (B-Eos), forced expiratory volume in 1 s (FEV1), and fraction of exhaled nitric oxide (FeNO) levels at 1-week before and 8 and 52 weeks after ESS.Results: Twenty-five subjects were analyzed. The ACQ score, B-Eos, and FeNO decreased, and FEV1 increased significantly after ESS. In the period from baseline to 52 weeks after ESS, changes in ACQ were significantly correlated with the changes in blood eosinophil counts (r = 0.58, p<.01) and FeNO (r = 0.45, p<.05). Ten subjects (40%) showed consistently improved asthma control at 52-weeks after ESS. In the remaining subjects, although the ACQ score temporarily improved at 8-weeks after ESS, but eventually deteriorated at 52-weeks. Higher levels of total immunoglobulin E were associated with long-term improved asthma control after ESS.Conclusions: In eosinophilic CRSwNP patients with asthma, sinus surgery impacts asthma control through the suppression of airway/systemic type 2 inflammation. The present study reinforced the common pathophysiology of type 2 inflammation between the upper and lower airways.
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Affiliation(s)
- Kazuki Hamada
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Keiji Oishi
- Department of Medicine and Clinical Science, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Ayumi Chikumoto
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Keita Murakawa
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Yuichi Ohteru
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Kazuki Matsuda
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Sho Uehara
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Ryo Suetake
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Shuichiro Ohata
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Yoriyuki Murata
- Department of Medicine and Clinical Science, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Yoshikazu Yamaji
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Maki Asami-Noyama
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Kosuke Ito
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Nobutaka Edakuni
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Tsunahiko Hirano
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
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48
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Workman AD, Miyake MM, Nocera AL, Mueller SK, Finn K, Otu HH, Libermann TA, Bleier BS. Unexpected effects of systemic steroids on the CRSwNP proteome: is protein upregulation more important than inhibition? Int Forum Allergy Rhinol 2020; 10:334-342. [PMID: 32022468 DOI: 10.1002/alr.22497] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Oral steroids, traditionally thought of as immunosuppressive agents that are broad in their immunomodulatory effects, are a mainstay of treatment to reduce disease burden in chronic rhinosinusitis with nasal polyps (CRSwNP). The purpose of this study was to determine how differentially expressed proteins in CRSwNP are affected by oral steroid therapy. METHODS Matched exosomal proteomic arrays were quantified using aptamer-based methods in systemic steroid-naive CRSwNP patients before and after a standardized oral prednisone course (n = 12). Previously identified differentially expressed proteins in CRSwNP patients were compared to determine the effect of steroids on expression. Fisher's exact test and t test were applied to normalized protein expression profiles to determine significance. RESULTS Of 18 proteins previously identified to be highly underexpressed in CRSwNP, 16 (89%) had an average increase after systemic steroid treatment (p < 0.05). Lactoperoxidase, initially present at 9-fold lower concentrations in CRSwNP subjects, increased by 209% after steroid treatment. A similar trend was observed with other proteins of interest, including platelet factor 4 and C-C motif ligand 28. The converse of this steroid effect was not true; of the 53 proteins that are highly overexpressed in CRSwNP, only 22 (42%) decreased in quantity with steroid use. CONCLUSION Proteomic analysis of differentially expressed proteins in CRSwNP demonstrates that systemic steroids cause almost uniform upregulation of transcriptionally decreased proteins, whereas the effects of steroids on transcriptionally increased proteins are more heterogeneous. Thus, proteomic analysis may be an effective tool to understand specific therapeutic benefits of steroid use in polyp disease and to create more targeted treatments.
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Affiliation(s)
- Alan D Workman
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.,Harvard Medical School, Boston, MA
| | - Michelle M Miyake
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.,Harvard Medical School, Boston, MA
| | - Angela L Nocera
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.,Harvard Medical School, Boston, MA
| | - Sarina K Mueller
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.,Harvard Medical School, Boston, MA.,Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Kristen Finn
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - Hasan H Otu
- Department of Electrical and Computer Engineering, University of Nebraska-Lincoln, Lincoln, NE
| | - Towia A Libermann
- Harvard Medical School, Boston, MA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.,Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Boston, MA.,Genomics, Proteomics, Bioinformatics and Systems Biology Center, Beth Israel Deaconess Medical Center, Boston, MA
| | - Benjamin S Bleier
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.,Harvard Medical School, Boston, MA
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49
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Mueller SK, Nocera AL, Workman A, Libermann T, Dillon ST, Stegmann A, Wurm J, Iro H, Wendler O, Bleier BS. Significant polyomic and functional upregulation of the PAPP-A/IGFBP-4/5/IGF-1 axis in chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 2020; 10:546-555. [PMID: 31930684 DOI: 10.1002/alr.22512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 10/27/2019] [Accepted: 11/04/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with epithelial expansion and polyp survival. However, the molecular mechanism of this aberrant proliferation is unclear. The purpose of this study was to interrogate derangements of the pappalysin-A/insulin-like growth factor binding protein/insulin-like growth factor-1 (PAPP-A/IGFBP-4/5/IGF-1 axis) as a major contributing factor to polyp growth in CRSwNP. METHODS Matched tissue and exosomal proteomic arrays including PAPP-A, IGFBP-4, IGFBP-5, and IGF-1 were quantified using aptamer-based methods/Western blots for proteomic analysis and whole-transcriptome sequencing/quantitative polymerase chain reaction (qPCR) for transcriptomic analysis in CRSwNP and control patients. Functional PAPP-A assays were then performed in both tissue and exosomes (set 1: n = 20 per group; validation set 2: n = 26 per group). RESULTS Tissue and exosomal PAPP-A was significantly overexpressed in CRSwNP compared to controls on both a transcriptomic and proteomic level (p < 0.0001). Known inhibitors of PAPP-A (stanniocalcin-1/-2) were significantly downregulated (p < 0.0001) as were PAPP-A cleavage products (IGFBP-5 p < 0.0001). PAPP-A function was shown to be increased 5-fold to 6-fold in tissue and exosomes. CONCLUSION Upregulated tissue and exosomal PAPP-A signaling is significantly associated with CRSwNP and may be an important factor in the promotion of epithelial proliferation and polyp growth. These data lend further support to the emerging concept of exosomal functional and polyomic analyses as a method to study sinonasal pathology.
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Affiliation(s)
- Sarina K Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University, Erlangen-Nürnberg (FAU), Erlangen, Germany.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Angela L Nocera
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Alan Workman
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Towia Libermann
- Department of Medicine, Beth Israel Deaconess Medical Center (BIDMC) Genomics, Proteomics, Bioinformatics and Systems Biology Center, Division of Interdisciplinary Medicine and Biotechnology, BIDMC, Harvard Medical School, Boston, MA
| | - Simon T Dillon
- Department of Medicine, Beth Israel Deaconess Medical Center (BIDMC) Genomics, Proteomics, Bioinformatics and Systems Biology Center, Division of Interdisciplinary Medicine and Biotechnology, BIDMC, Harvard Medical School, Boston, MA
| | - Achim Stegmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University, Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jochen Wurm
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University, Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University, Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Olaf Wendler
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University, Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Benjamin S Bleier
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
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50
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Hox V, Lourijsen E, Jordens A, Aasbjerg K, Agache I, Alobid I, Bachert C, Boussery K, Campo P, Fokkens W, Hellings P, Hopkins C, Klimek L, Mäkelä M, Mösges R, Mullol J, Pujols L, Rondon C, Rudenko M, Toppila-Salmi S, Scadding G, Scheire S, Tomazic PV, Van Zele T, Wagemann M, van Boven JFM, Gevaert P. Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position paper. Clin Transl Allergy 2020; 10:1. [PMID: 31908763 PMCID: PMC6941282 DOI: 10.1186/s13601-019-0303-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 12/02/2019] [Indexed: 02/05/2023] Open
Abstract
Because of the inflammatory mechanisms of most chronic upper airway diseases such as rhinitis and chronic rhinosinusitis, systemic steroids have been used for their treatment for decades. However, it has been very well documented that—potentially severe—side-effects can occur with the accumulation of systemic steroid courses over the years. A consensus document summarizing the benefits of systemic steroids for each upper airway disease type, as well as highlighting the potential harms of this treatment is currently lacking. Therefore, a panel of international experts in the field of Rhinology reviewed the available literature with the aim of providing recommendations for the use of systemic steroids in treating upper airway disease.
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Affiliation(s)
- Valerie Hox
- 1Cliniques Universitaires Saint-Luc Brussels, Av. Hippocrate 10, 1200 Brussels, Belgium
| | - Evelijn Lourijsen
- 2Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC, Amsterdam, The Netherlands
| | - Arnout Jordens
- 3Upper Airway Research Laboratory, Dep. of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | | | - Ioana Agache
- Faculty of Medicine, Transsylvania University, Brasov, Romania
| | - Isam Alobid
- 6Hospital Clínic, IDIBAPS, CEBERES Universitat de Barcelona, Catalonia, Spain.,7Centro Medico Teknon, Barcelona, Spain
| | - Claus Bachert
- 3Upper Airway Research Laboratory, Dep. of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium.,8Department of Ear, Nose and Throat Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Koen Boussery
- 9Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Paloma Campo
- 10Allergy Unit, Hospital Regional Universitario of Málaga, IBIMA, ARADyAL, Malaga, Spain
| | - Wytske Fokkens
- 2Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC, Amsterdam, The Netherlands
| | - Peter Hellings
- 11Department of Ear, Nose and Throat Disease, University Hospitals, Louvain, Belgium
| | - Claire Hopkins
- 12ENT Department, Guy's & St Thomas' Hospital, London, UK
| | - Ludger Klimek
- Center of Rhinology and Allergology, Wiesbaden, Germany
| | - Mika Mäkelä
- 14Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Joaquim Mullol
- 6Hospital Clínic, IDIBAPS, CEBERES Universitat de Barcelona, Catalonia, Spain
| | - Laura Pujols
- 6Hospital Clínic, IDIBAPS, CEBERES Universitat de Barcelona, Catalonia, Spain
| | - Carmen Rondon
- 10Allergy Unit, Hospital Regional Universitario of Málaga, IBIMA, ARADyAL, Malaga, Spain
| | | | - Sanna Toppila-Salmi
- 14Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Sophie Scheire
- 9Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | | | - Thibaut Van Zele
- 3Upper Airway Research Laboratory, Dep. of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | | | - Job F M van Boven
- 20Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
| | - Philippe Gevaert
- 3Upper Airway Research Laboratory, Dep. of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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