Osteitis in Chronic Rhinosinusitis
AbstractPurpose of ReviewOsteitis is recognized as a common factor in recalcitrant chronic rhinosinusitis (CRS). There is evidence for the association of osteitis with revision surgeries and CRS severity, in terms of higher Lund-Mackay scores. This is a narrative review on the osteitis in CRS patients.Recent FindingsEvidence to date is inconclusive with regard to the etiology and pathogenesis of this bony thickening. Histopathology of osteitis in primary CRS is likely a process of neo-osteogenesis and bone remodeling. For better understanding, various associating factors have been studied including an inflammatory pattern of rhinosinusitis. Recent studies have associated osteitis with nasal polyps and tissue eosinophilia with the increase in periostin expression and P-glycoprotein mucosal expression. There is no association of osteitis to symptoms or quality of life. Osteitis is an outcome of neo-osteogenesis rather than inflammatory processes in CRS patients without a prior history of surgery. While CT has become a staple in osteitis assessment, the standards for grading osteitic severity remain in an experimental stage. There is no association between the presence or severity of osteitis at the time of surgery and clinical outcomes at 1 year after surgery.SummaryThis review provides a comprehensive overview of the pathogenesis, epidemiology, and correlation with clinical and biological factors of osteitis in CRS patients.
ConclusionsPrognosis in patients with CRSwNP was inferior to that in patients with CRSsNP. Asthma was the only factor that increased the chance of recurrence in patients with either CRSsNP or CRSwNP.
CONCLUSIONS: Collection of nasal secretions on the filter paper is a practical and non-invasive method for in-depth study of nasal proteomics. Our proteomic signatures also support that Asian NPs could be characterized as non-eosinophilic inflammation features. Therefore, the proteomic profiling of nasal secretions from CRS patients may enhance our understanding of CRS endotypes. PMID: 31332980 [PubMed]
CONCLUSIONS: Our results suggest that Th17/Th1-associated mediators and BAFF may play a role and be a potential therapeutic target in refractory CRSwNP. Additionally, eosinophilic markers and autoantibodies may contribute to refractoriness in asthmatic rNP. PMID: 31332978 [PubMed]
Aspirin-exacerbated respiratory disease (AERD) is a syndrome characterized by asthma that is often severe with progressive airway remodeling, the presence of eosinophilic chronic sinusitis with nasal polyp (CRSwNP) formation, and intolerance to aspirin and other non-selective cyclooxygenase 1 (COX-1) inhibitors.1 The prevalence of AERD in the general population is 1% which increases to 7% amongst those with asthma. In the most severe cases, ingestion of aspirin can trigger systemic reactions and even death.
CONCLUSIONS: CRSwNP patients have significantly lower HRQoL compared with population norms. The impact is greater in patients with greater disease severity, comorbidities, or refractory disease. PMID: 31318362 [PubMed - as supplied by publisher]
BackgroundCystatins are epithelial protease inhibitors that participate in sinonasal immunity and inflammation. Nasal mucus –derived exosomes (NMDEs) are small vesicles secreted by epithelial cells that carry protein cargo reflective of their host cell. NMDEs have been used as a noninvasive biomarker source to study chronic rhinosinusitis with nasal polyps (CRSwNP) proteomics with superior sensitivity to whole mucus. T he purpose of this study was to noninvasively quantify exosomal cystatins in a heterogenous population to determine their utility in predicting phenotype and disease severity.MethodsThis was an Institu...
15-Lipoxygenase 1 (15LO1) is expressed in airway epithelial cells in patients with type 2 –high asthma in association with eosinophilia. Chronic rhinosinusitis with nasal polyps (CRSwNP) is also associated with type 2 inflammation and eosinophilia. CCL26/eotaxin 3 has been reported to be regulated by 15LO1 in lower airway epithelial cells. However, its relation to 15LO1 in patients wit h CRSwNP or mechanisms for its activation are unclear.
Chronic rhinosinusitis (CRS) is a chronic disease of the upper airways that is both common, as it affects more than 10 million Americans1, and economically onerous, as it is associated an annual loss of 60 paid work days missed per patient from both absenteeism and presenteeism2. CRS is associated with a significant decline in quality of life (QOL)3. The majority of CRS patients do not improve with current medical options and need to undergo repetitive surgeries. Not surprisingly, CRS is associated with a high financial burden on society with an estimated 60 billion dollars per year 4.
PMID: 31295554 [PubMed - as supplied by publisher]
Purpose of review Nonsteroidal anti-inflammatory drug (NSAID) is one of the most frequently prescribed medications in the medical field, and hypersensitivity to NSAID is a common adverse drug reaction encountered. However, NSAID hypersensitivity presents a variety of symptoms caused by diverse pharmacological and immunological mechanisms. Recent findings Owing to the heterogeneity of the disease, a new concept for the classification of NSAID hypersensitivity has recently been proposed to diagnose and manage NSAID hypersensitivity for personalized treatment. Acute and delayed reactions were distinguished in this classi...