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Livingston R, Bellas H, Sahota J, Bidder T, Vogt F, Lund VJ, Gane SB, Robinson DS, Kariyawasam HH. Breathing pattern disorder in chronic rhinosinusitis with severe asthma: nasal obstruction and polyps do not increase prevalence. J Asthma 2024; 61:177-183. [PMID: 37668326 DOI: 10.1080/02770903.2023.2255277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/21/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Chronic rhinosinusitis (CRS) with severe asthma are associated with breathing pattern disorder (BPD). Mouth breathing is a sign of breathing pattern disorder, and nose breathing a fundamental part of breathing pattern retraining for BPD. The prevalence of BPD in relation to CRS subtypes and the relationship of nasal obstruction to BPD in CRS and associated severe asthma is unknown. The breathing pattern assessment tool (BPAT) can identify BPD. Our objective was to thus investigate the prevalence of BPD, nasal airflow obstruction and measures of airway disease severity in CRS with (CRSwNP) and without nasal polyps (CRSsNP) in severe asthma. METHODS We determined whether CRS status, peak nasal inspiratory flow (PNIF) or polyp disease increased BPD prevalence. Demographic factors, measures of airway function and breathlessness in relation to BPD status and CRS subtypes were also evaluated. RESULTS 130 Patients were evaluated (n = 69 had BPD). The prevalence of BPD in CRS with severe asthma was 53.1%. There was no difference between BPD occurrence between CRSwNP and CRSsNP. The mean polyp grade and PNIF were not statistically different between the BPD and non-BPD group. The presence of nasal polyps did not increase breathlessness. CONCLUSIONS BPD and CRS are commonly co-associated. CRS status and nasal obstruction per se does not increase BPD prevalence.
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Affiliation(s)
- Rebecca Livingston
- Therapy and Rehabilitation Department, University College London Hospital NHS Foundation Trust, London, UK
- Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
| | - Helene Bellas
- Therapy and Rehabilitation Department, University College London Hospital NHS Foundation Trust, London, UK
- Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
| | - Jagdeep Sahota
- Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
- Ear Institute, University College London, London, UK
| | - Therese Bidder
- Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
- Allergy and Clinical Immunology, Royal National ENT Hospital, London, UK
| | - Florian Vogt
- Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
| | - Valerie J Lund
- Ear Institute, University College London, London, UK
- Rhinology Section, Royal National ENT Hospital, London, UK
| | - Simon B Gane
- Ear Institute, University College London, London, UK
- Rhinology Section, Royal National ENT Hospital, London, UK
| | - Douglas S Robinson
- Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
| | - Harsha H Kariyawasam
- Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
- Allergy and Clinical Immunology, Royal National ENT Hospital, London, UK
- Rhinology Section, Royal National ENT Hospital, London, UK
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Kariyawasam HH, Chandrasekharan DP, Jacques T, Stokes P, Dziadzio M, Gane SB, Langan D, Rimmer J. Biologic treatment for severe chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis. Rhinology 2023; 61:98-107. [PMID: 37023247 DOI: 10.4193/rhin22.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps is often severe, debilitating and difficult to treat. Biologics that target key inflammatory pathways have the potential to treat this disease; this study aimed to evaluate their effectiveness. METHODOLOGY Systematic review and meta-analysis of randomised controlled trials of biologics in chronic rhinosinusitis with nasal polyps. Primary outcomes were extent of disease, objective disease severity and disease-specific quality of life, with outcomes measured at different end-of-treatment timepoints in different studies (range 16-52 weeks). RESULTS Eleven trials were identified with 2035 participants. Ten studies reported change in polyp size, estimating a reduction of -1.25 in the treatment group. Six studies reported reduction in Lund-Mackay score where the pooled mean difference was -4.90. Five studies included peak nasal inspiratory flow with a pooled mean difference of 33.54, indicating improved nasal airflow. Seven studies reported change in olfactory score with an overall pooled effect of 6.56 suggesting improved olfaction. The SNOT-22 score in nine studies gave an overall pooled effect of -14.53, indicating improved quality of life. CONCLUSIONS Biologics can be effective in treating nasal polyps, with reduction in polyp size and extent of disease, and improved sense of smell and quality of life. There is significant heterogeneity in the outcomes for individual biologics, highlighting the need for further studies.
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Affiliation(s)
- H H Kariyawasam
- Allergy and Clinical Immunology, Royal National ENT Hospital, London, UK and Rhinology Section, Royal National ENT Hospital, London, UK
| | | | - T Jacques
- Department of Otolaryngology, St George's University Hospital, London, UK
| | - P Stokes
- Department of Otolaryngology Head and Neck Surgery, Monash Health, Melbourne, Australia
| | - M Dziadzio
- Allergy and Clinical Immunology, Royal National ENT Hospital, London, UK and University College London, London, UK
| | - S B Gane
- Rhinology Section, Royal National ENT Hospital, London, UK and University College London, London, UK
| | - D Langan
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - J Rimmer
- Department of Otolaryngology Head and Neck Surgery, Monash Health, Melbourne, Australia and Department of Surgery, Monash University, Melbourne, Australia and Department of Otolaryngology Head and Neck Surgery, St Vincent's Hospital Melbourne, Australia
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Fokkens WJ, Mullol J, Kennedy D, Philpott C, Seccia V, Kern RC, Coste A, Sousa AR, Howarth PH, Benson VS, Mayer B, Yancey SW, Chan R, Gane SB. Mepolizumab for chronic rhinosinusitis with nasal polyps (SYNAPSE): In-depth sinus surgery analysis. Allergy 2023; 78:812-821. [PMID: 35822924 DOI: 10.1111/all.15434] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/10/2022] [Accepted: 06/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) often require repeat sinus surgery. Mepolizumab reduced the need for sinus surgery in the SYNAPSE trial; this analysis sought to provide a more in-depth assessment of surgery endpoints in SYNAPSE. METHODS SYNAPSE was a double-blind Phase III trial (NCT03085797) in adults with recurrent, refractory, severe, CRSwNP eligible for repeat sinus surgery despite standard of care treatments and previous surgery. Patients were randomized (1:1) to mepolizumab 100 mg subcutaneously or placebo, plus standard of care, every 4 weeks for 52 weeks. Time to first inclusion on a waiting list for sinus surgery and time to first actual sinus surgery (both up to week 52) were assessed; the latter endpoint was also analyzed post hoc according to time since last sinus surgery before study screening and baseline blood eosinophil count. RESULTS Among 407 patients (mepolizumab: 206; placebo: 201), mepolizumab versus placebo reduced the risk of being included on a waiting list for sinus surgery (week 52 Kaplan-Meier probability estimate [95% confidence interval]: 13.9% [9.8%, 19.5%] vs. 28.5% [22.7%, 35.4%]). Mepolizumab versus placebo reduced the risk of sinus surgery irrespective of time (<3 vs ≥3 years) since patients' last sinus surgery prior to study screening (hazard ratios [95% confidence intervals] 0.28 [0.09, 0.84] and 0.50 [0.26, 0.98], respectively) and baseline blood eosinophil count. CONCLUSIONS Mepolizumab reduced the risk of further sinus surgery in patients with recurrent, refractory, severe CRSwNP, irrespective of the patient baseline characteristics assessed.
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Affiliation(s)
- Wytske J Fokkens
- Department of Otolaryngology, University of Amsterdam, Amsterdam, Netherlands
| | - Joaquim Mullol
- Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | - David Kennedy
- Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carl Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK.,Norfolk and Waveney Ear Nose and Throat Service, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Veronica Seccia
- ENT Unit, Department of Neuroscience, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Robert C Kern
- Department of Medicine and Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - André Coste
- Service d'ORL et de Chirurgie Cervico-faciale Centre, Hospitalier Intercommunal de Creteil, et APHP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Universite Paris-Est Creteil, Creteil, France
| | - Ana R Sousa
- Clinical Sciences, Respiratory, GSK, GSK House, Brentford, Middlesex, UK
| | - Peter H Howarth
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK.,Global Respiratory Franchise, GSK House, Brentford, Middlesex, UK
| | - Victoria S Benson
- Epidemiology, Value Evidence and Outcomes, GSK House, Brentford, Middlesex, UK
| | - Bhabita Mayer
- Clinical Statistics, GSK House, Brentford, Middlesex, UK
| | - Steve W Yancey
- Respiratory Medical Franchise, GSK, Research Triangle Park, North Carolina, USA
| | - Robert Chan
- Clinical Sciences, Respiratory, GSK, GSK House, Brentford, Middlesex, UK
| | - Simon B Gane
- Department of Rhinology, Royal National ENT Hospital, University College London Hospitals NHS Foundation Trust, London, UK.,UCL Ear Institute, University College London, London, UK
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Yang B, Dziadzio M, Meridamorillas M, Joseph JA, Gane SB, James LK, Kariyawasam HH. Chronic rhinosinusitis: Eosinophil blood reference values and decision limits and tissue count intravariability. Clin Otolaryngol 2021; 46:1142-1145. [PMID: 33932260 DOI: 10.1111/coa.13793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/08/2021] [Accepted: 04/11/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Baoran Yang
- Specialist Allergy and Clinical Immunology, London, UK.,Rhinology Section, Royal National ENT Hospital, University College London Hospitals NHS Foundation Trust, London, UK.,Ear Institute, University College London, London, UK
| | - Magdalena Dziadzio
- Specialist Allergy and Clinical Immunology, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Marta Meridamorillas
- Rhinology Section, Royal National ENT Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jonathan A Joseph
- Rhinology Section, Royal National ENT Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - Simon B Gane
- Rhinology Section, Royal National ENT Hospital, University College London Hospitals NHS Foundation Trust, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Harsha H Kariyawasam
- Specialist Allergy and Clinical Immunology, London, UK.,Rhinology Section, Royal National ENT Hospital, University College London Hospitals NHS Foundation Trust, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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5
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Vogt F, Sahota J, Bidder T, Livingston R, Bellas H, Gane SB, Lund VJ, Robinson DS, Kariyawasam HH. Chronic rhinosinusitis with and without nasal polyps and asthma: Omalizumab improves residual anxiety but not depression. Clin Transl Allergy 2021; 11:e12002. [PMID: 33900051 PMCID: PMC8099201 DOI: 10.1002/clt2.12002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/11/2021] [Indexed: 11/11/2022] Open
Abstract
Background Chronic rhinosinusitis (CRS) has a high prevalence of anxiety and depression. It is currently uncertain if treatment in patients with CRS with or without nasal polyps (CRSwNP and CRSsNP) has any impact on improving mental health outcomes. The aims here were to document anxiety and depression in patients with severe CRS and asthma already treated with appropriate medical therapy. We then evaluated whether further maximal treatment with omalizumab improved anxiety and/or depression alongside improvements in CRS and coassociated asthma. Methods Hospital Anxiety and Depression Scale (HADS) scores along with measures of CRS and asthma severity were recorded according to CRSwNP and CRSsNP status in n = 95 patients with severe CRS and asthma. Of this group, a further n = 23 had omalizumab for associated allergic asthma. Follow‐up measures were collected 16 weeks after omalizumab treatment. Results HADS anxiety and depression prevalence in CRS were 49.47 % and 38.95%, respectively. Within the CRSwNP and CRSsNP group 53.06% and 45.66% had raised HADS‐anxiety scores. Abnormal HADS‐depression scores were present in 40.82% and 36.95% of the CRSwNP and CRSsNP groups, respectively. Correlations for sinonasal outcome test‐22 (SNOT‐22) versus HADS total was r = 0.59 p < 0.0001, HADS‐anxiety r = 0.56 p < 0.0001 and HADS‐depression r = 0.49 p < 0.0001. Omalizumab improved anxiety in CRS (p < 0.0001) regardless of nasal polyp status (CRSwNP p = 0.0042 and CRSsNP p = 0.0078). Depression scores did not improve in either group. SNOT‐22 (p = 0.0006), asthma control questionnaire‐7 (p = 0.0019) and mini‐asthma quality of life questionnaire including emotional function (p = 0.0003 and p = 0.0009, respectively) all improved in both subgroups. Conclusion In CRS and asthma, anxiety scores but not depression improved after omalizumab treatment. Anxiety may be closely related to airway disease severity, but depression may be independent of airway disease itself. If so, a separate mental health care pathway is needed for CRS patients with depression.
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Affiliation(s)
- Florian Vogt
- Department of Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
| | - Jagdeep Sahota
- Department of Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK.,Rhinology UCL Ear Institute, University College London, London, UK
| | - Therese Bidder
- Department of Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
| | - Rebecca Livingston
- Department of Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
| | - Helene Bellas
- Department of Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
| | - Simon B Gane
- Rhinology UCL Ear Institute, University College London, London, UK.,Rhinology Section, Royal National ENT Hospital, London, UK
| | - Valerie J Lund
- Rhinology UCL Ear Institute, University College London, London, UK.,Rhinology Section, Royal National ENT Hospital, London, UK
| | - Douglas S Robinson
- Department of Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK
| | - Harsha H Kariyawasam
- Department of Respiratory Medicine, University College London Hospital NHS Foundation Trust, London, UK.,Rhinology UCL Ear Institute, University College London, London, UK.,Rhinology Section, Royal National ENT Hospital, London, UK
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6
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Kariyawasam HH, Leandro M, Dziadzio M, Robinson DS, Lund VJ, Gane SB. Chronic Rhinosinusitis With Nasal Polyps In Patients With Aspirin Sensitivity-Mycophenolate Mofetil as an Effective Steroid-Sparing Agent. JAMA Otolaryngol Head Neck Surg 2020; 147:2771314. [PMID: 33030525 DOI: 10.1001/jamaoto.2020.3401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
- Harsha H Kariyawasam
- Rhinology Section, Royal National ENT Hospital, London, United Kingdom
- University College London Hospital NHS Foundation Trust,, London, United Kingdom
- University College London, London, United Kingdom
| | - Maria Leandro
- University College London Hospital NHS Foundation Trust,, London, United Kingdom
- University College London, London, United Kingdom
| | - Magdalena Dziadzio
- Rhinology Section, Royal National ENT Hospital, London, United Kingdom
- University College London Hospital NHS Foundation Trust,, London, United Kingdom
- University College London, London, United Kingdom
| | - Douglas S Robinson
- University College London Hospital NHS Foundation Trust,, London, United Kingdom
- University College London, London, United Kingdom
| | - Valerie J Lund
- Rhinology Section, Royal National ENT Hospital, London, United Kingdom
- University College London, London, United Kingdom
| | - Simon B Gane
- Rhinology Section, Royal National ENT Hospital, London, United Kingdom
- University College London Hospital NHS Foundation Trust,, London, United Kingdom
- University College London, London, United Kingdom
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Abstract
BACKGROUND The amelioration of the current COVID pandemic relies on swift and efficient case finding as well as stringent social distancing measures. Current advice suggests that fever or new onset dry cough are the commonest presenting complaints. METHODOLOGY We present a case report and case series as well as other evidence that there is an important fourth presenting syndrome, namely isolated sudden onset anosmia (ISOA), which should be considered highly suspicious for SARS-CoV-2. RESULTS A patient presenting with ISOA who went on to test positive for infection with COVID-19 and did not develop any further symptoms as well as a case series of similar patients although limited by the lack of reliable testing at the moment. CONCLUSIONS We posit the existence of a fourth common syndrome of COVID-19 infection: isolated sudden onset anosmia (ISOA) and urge the international community to consider this presentation in current management advice.
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Affiliation(s)
- S B Gane
- Royal National Ear, Nose and Throat and Eastman Dental Hospitals, London, United Kingdom
| | - C Kelly
- AbScent, 14 London Road, Andover, Hampshire, United Kingdom
| | - C Hopkins
- Guy's and St Thomas'; Hospitals, London, United Kingdom
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8
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Kariyawasam HH, James LK, Gane SB. Dupilumab: Clinical Efficacy of Blocking IL-4/IL-13 Signalling in Chronic Rhinosinusitis with Nasal Polyps. Drug Des Devel Ther 2020; 14:1757-1769. [PMID: 32440101 PMCID: PMC7217316 DOI: 10.2147/dddt.s243053] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/29/2020] [Indexed: 12/17/2022]
Abstract
In September 2019, The Lancet published details of two large Phase III double-blind placebo-controlled studies (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52) confirming the clinical efficacy of the biologic dupilumab in simultaneously blocking both IL-4/IL-13 signalling in chronic rhinosinusitis with nasal polyps (CRSwNP). The studies demonstrated that dupilumab (Dupixent®, Sanofi and Regeneron) 300mg subcutaneously administered was clinically effective when added for patients with moderate to severe CRSwNP already maintained on the standard intranasal steroid mometasone furoate. Duration of treatment ranged from injections either 2 weekly for 24 weeks (SINUS-24) or every 2 weeks for 52 weeks or finally every 2 weeks for 24 weeks stepping down thereafter to every 4 weeks for a further 28 weeks (SINUS-52). Rapid improvements in all important parameters of disease burden were seen with such improvement maintained even where the frequency of injections was decreased. In patients with co-existent asthma, lung function and asthma control scores improved. This is consistent with the one airway hypothesis of shared T2 inflammatory programmes driving both disease syndromes. The studies formed the basis for FDA registration and clinical launch in the US, and EMA approval in Europe. Dupilumab presents a significant new treatment option in an area of urgent unmet therapeutic need in CRSwNP. Should dupilumab prove to be as effective in the real-life clinical environment as it has been in the studies, then a paradigm shift from sinonasal surgery to medical treatment of CRSwNP may need to occur in the ENT community. Questions in relation to best patient selection, combined upper and lower airway therapeutic pathways, long-term safety along with health economics and cost constraints ought now to be addressed.
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Affiliation(s)
- Harsha H Kariyawasam
- Department of Specialist Allergy and Clinical Immunology, Royal National ENT Hospital, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rhinology, Royal National ENT Hospital, University College London Hospitals NHS Foundation Trust, London, UK.,UCL Ear Institute , University College London, London, UK
| | - Louisa K James
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Simon B Gane
- Department of Rhinology, Royal National ENT Hospital, University College London Hospitals NHS Foundation Trust, London, UK.,UCL Ear Institute , University College London, London, UK
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9
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Kariyawasam HH, Gane SB. Allergen-induced asthma, chronic rhinosinusitis and transforming growth factor-β superfamily signaling: mechanisms and functional consequences. Expert Rev Clin Immunol 2019; 15:1155-1170. [PMID: 31549888 DOI: 10.1080/1744666x.2020.1672538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction: Often co-associated, asthma and chronic rhinosinusitis (CRS) are complex heterogeneous disease syndromes. Severity in both is related to tissue inflammation and abnormal repair (termed remodeling). Understanding signaling factors that can modulate, integrate the activation, and regulation of such key processes together is increasingly important. The transforming growth factor (TGF)-β superfamily of ligands comprise a versatile system of immunomodulatory molecules that are gaining recognition as having an essential function in the immunopathogenesis of asthma. Early data suggest an important role in CRS as well. Abnormal or dysregulated signaling may contribute to disease pathogenesis and severity.Areas covered: The essential biology of this complex family of growth factors in relation to the excess inflammation and remodeling that occurs in allergic asthma and CRS is reviewed. The need to understand the integration of signaling pathways together is highlighted. Studies in human airway tissue are evaluated and only selected key animal models relevant to human disease discussed given the highly context-dependent signaling and function of these ligands.Expert opinion: Abnormal or dysregulated TGF-β superfamily signaling may be central to the excess inflammation and tissue remodeling in asthma, and possibly CRS. Therefore, the TGF-β superfamily signaling pathways represent an emerging and attractive therapeutic target.
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Affiliation(s)
- Harsha H Kariyawasam
- Department of Adult Specialist Allergy and Clinical Immunology, Royal National ENT Hospital, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rhinology, Royal National ENT Hospital, University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Simon B Gane
- Department of Rhinology, Royal National ENT Hospital, University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
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10
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Abstract
Epistaxis due to internal carotid artery (ICA) trauma is uncommon, and that due to aneurysm of the artery is rarer still. Most cases result in fatality due to severe, uncontrolled blood loss. The ICA is vulnerable to oropharyngeal trauma as it ascends beside the lateral pharyngeal wall. We describe a case of an 11-month-old girl who sustained oropharyngeal wall trauma from the handle of a wooden spoon. After a characteristic latent period of several days, upper airway obstruction occurred due to a right parapharyngeal mass, which extended inferiorly to the level of the larynx. Angiography confirmed a large dissecting ICA aneurysm. This was treated successfully by radiological coil occlusion.
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Affiliation(s)
- Pandora J Hadfield
- Department of ENT, Great Ormond Street Hospital for Children, London WC1N 3JH, UK
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