Endotypes of chronic rhinosinusitis: impact on management
Following the trend in asthma, endotypes for chronic rhinosinusitis with nasal polyps (CRSwNP) have been established, with Type 2 immune reactions representing 80-100% of nasal polyp cases in Europe and the US. Endotyping is without doubt useful to predict the natural course of disease, to determine pharmacotherapy and the extent of surgery, and lately also to select patients for Type 2 biologics. However, with the opening of this new era of treatment, also limitations of the current possibilities in subgrouping patients became apparent, as 1) mixed endotypes often can be found and 2) predictions on the best biologic to be used in an individual patient are not possible yet.
AbstractPurpose of ReviewThis review summarizes the latest information on the appropriate identification, evaluation, and treatment of patients with nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NSAID-ERD), also known as aspirin-exacerbated respiratory disease (AERD). Within the framework of our understanding of the underlying pathophysiology of NSAID-ERD, we also provide an update regarding new surgical techniques and newly available or upcoming medical therapies that may benefit these patients.Recent FindingsThere have been considerable developments regarding recommendations for both the ex...
Chronic rhinosinusitis (CRS) includes two main phenotypes: without nasal polyps (CRSsNP) and with nasal polyps (CRSwNP). CRS has been reported to be a comorbidity of asthma. Objective The current study aimed to investigate the role of CRS in asthmatic outpatients visited in a real-world setting.
CONCLUSION: The present study confirmed that CRS is frequent asthma comorbidity as concerns more than one-third of asthmatic outpatients. CRSwNP is associated with type 2 inflammation and blood eosinophilia. These outcomes underline that CRSwNPasthma phenotype deserves adequate attention for careful management and optimal identification of the best-tailored therapy. PMID: 32171930 [PubMed - as supplied by publisher]
CONCLUSIONS: IL-17A possibly plays a role in the pathogenesis of CRSwNP, the major cellular source being M1 macrophage in NP tissues. Targeting IL-17A directly or indirectly may be an effective therapeutic strategy for CRSwNP. PMID: 32141263 [PubMed]
BackgroundKetotifen is a second ‐generation noncompetitive H1‐antihistamine and mast‐cell stabilizer. It is commonly used to treat or prevent allergic conjunctivitis, asthma, chronic urticaria, anaphylaxis, mast‐cell, and other allergic‐type disorders. However, it has never been studied in aspirin‐exacerbated respirato ry disease (AERD), an aggressive phenotype of chronic rhinosinusitis with nasal polyps, where the mast cell plays a prominent role its pathogenesis.MethodsHuman sinonasal epithelial cells were grown at an air ‐liquid interface (ALI). Ketotifen powder was dissolved in saline to make 4 test solut...
CONCLUSIONS: In the present study, we found the histopathological and radiographic evidence of osteogenesis using a previously established murine eosinophilic CRS NP model. This animal model could provide new insights into the pathophysiology of neo-osteogenesis and provide a basis for developing new therapeutics. PMID: 32009324 [PubMed]
CONCLUSIONS: Human nasal polyps harbor a population of LLPCs and NGF may be involved in their prolonged survival. LLPCs may be a novel therapeutic target for suppressing the local Ig production in nasal polyps. PMID: 32009322 [PubMed]
Authors: Khalmuratova R, Shin HW PMID: 32009318 [PubMed]
We examined the impact of mepolizumab on clinically significant exacerbations and health-related quality of life (HRQoL) in patients with severe eosinophilic asthma and upper respiratory comorbidities.
Atopic dermatitis (AD) is a chronic inflammatory skin disease that presents frequently with other concomitant atopic conditions such as asthma. Dupilumab is approved in the USA for adults and adolescents with inadequately controlled moderate-to-severe AD; as an add-on maintenance treatment for adults and adolescents with inadequately controlled eosinophilic/oral corticosteroid-dependent asthma; and as an add-on maintenance treatment in adults with inadequately controlled chronic rhinosinusitis with nasal polyps.