Printed From:

CHRONIC RHINOSINUSITIS WITH NASAL POLYPS
IS PREDOMINANTLY A TYPE 2 INFLAMMATORY DISEASE1-3

 
DID YOU KNOW?
Up to
80%

of patients with CRSwNP in the US
and EU have Type 2 inflammation1

IL-4, IL-13, and IL-5 are key drivers in CRSwNP4
IL-4 and IL-13 are central Type 2 cytokines
with distinct and overlapping roles3,4
CRSwNP involves a distinct Type 2 cytokine profile, including4,6,7:
A lack of regulatory T cell (Treg) function
Local IgE production induced by IL-4 and IL-13
Eosinophilic inflammation induced by IL-4 and IL-13
 

Type 2 comorbidities are common, and often exacerbated, in patients with CRSwNP1,8,9

Click on the airways to reveal more Type 2 inflammation comorbidities

Comorbidities associated with CRSwNP9-11:

Patients with severe asthma and CRSwNP have higher asthma symptom scores, elevated exacerbation rates, and increased loss of smell compared with asthma patients who have CRSsNP9
Without treatment, CRSwNP
can lead to2,12:
  • Loss of smell
  • Nasal obstruction/congestion that may cause difficulty with nasal breathing
  • Anterior/posterior rhinorrhea
  • Pain/pressure
  • Sleep disturbance
  • Chronic fatigue
  • Work absenteeism and reduced productivity
 

Current medical and surgical therapy for
CRSwNP may provide short-term benefits13

Systemic corticosteroids14,15

  • A short course of oral corticosteroids may be beneficial for patients; however, the benefit is unlikely to persist
  • Side effects with long-term exposure may limit their potential as a chronic therapy

Surgery8,15-17

  • Surgery aims to remove nasal obstruction, improving sinus ventilation and access for topical therapies
  • Patients with recurrent CRSwNP who need revision surgery express a predominant Type 2 inflammation phenotype (with increased IL-5, eosinophilic cationic protein, total IgE, and IgE specific to Staphylococcus aureus enterotoxin)
  • Revision surgery is often required, primarily in patients with comorbidities

In patients with CRSwNP, a UK study found18:

CRSwNP patients have a mean number of 3.3 previous surgeries per patient

Despite current treatments, there remains an unmet need for patients with CRSwNP
    aA study was conducted through electronic medical records at Northwestern in Chicago, Illinois. CRSwNP, asthma, and AERD patients were identified. The following demographic and clinical features were characterized: sex, atopy, and sinus disease severity.10

    AERD, aspirin-exacerbated respiratory disease; CRSsNP, chronic rhinosinusitis sans nasal polyps; ENP, endoscopic nasal polypectomy;
    NERD, NSAID-exacerbated respiratory disease.

    Upper airway comorbidities may signal
    Type 2 inflammation in the lower airway19,20
References:
  1. Chaaban MR, Walsh EM, Woodworth BA. Epidemiology and differential diagnosis of nasal polyps. Am J Rhinol Allergy. 2013;27(6):473-478.
  2. Palmer J, Messina J, Biletch R, Grosel K, Mahmoud R. Health care for chronic rhinosinusitis (CRS) symptoms—a cross-sectional, population-based survey of US adults meeting symptom criteria for CRS. Poster presented at: American Academy of Allergy, Asthma & Immunology Annual Meeting; March 3-6, 2017; Atlanta, GA.
  3. Gandhi NA, Bennett BL, Graham NMH, Pirozzi G, Stahl N, Yancopoulos GD. Targeting key proximal drivers of type 2 inflammation in disease. Nat Rev Drug Discov. 2016;15(1):35-50.
  4. Akdis CA, Bachert C, Cingi C, et al. Endotypes and phenotypes of chronic rhinosinusitis: a PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology. J Allergy Clin lmmunol. 2013;131(6):1479-1490.
  5. Schleimer RP. Immunopathogenesis of chronic rhinosinusitis and nasal polyposis. Annu Rev Pathol. 2017;12:331-357. doi:10.1146/annurev-pathol-052016-100401
  6. Stevens WW, Schleimer RP, Kern RC. Chronic rhinosinusitis with nasal polyps. J Allergy Clin lmmunol Pract. 2016;4(4):565-572.
  7. Kato A. lmmunopathology of chronic rhinosinusitis. Allergol Int. 2015;64(2):121-130.
  8. Bachert C, Pawankar R, Zhang L, et al. ICON: chronic rhinosinusitis. World Allergy Organ J. 2014;7(1):25. doi:10.1186/1939-4551-7-25
  9. Langdon C, Mullol J. Nasal polyps in patients with asthma: prevalence, impact, and management challenges. J Asthma Allergy. 2016;9:45-53.
  10. Gelardi M, Iannuzzi L, Tafuri S, Passalacqua G, Quaranta N. Allergic and non-allergic rhinitis: relationship with nasal polyposis, asthma and family history. Acta Otorhinolaryngol Ital. 2014;34(1):36-41.
  11. Stevens WW, Peters AT, Hirsch AG, et al. Clinical characteristics of patients with chronic rhinosinusitis with nasal polyps, asthma, and aspirin-exacerbated respiratory disease. J Allergy Clin lmmunol Pract. 2017;5(4):1061-1070.
  12. Liu T, Cooper T, Earnshaw J, Cervin A. Disease burden and productivity cost of chronic rhinosinusitis patients referred to a tertiary centre in Australia. Aust J Otolaryngol. 2018;1:5. doi:10.21037/ajo.2018.01.03
  13. Mendelsohn D, Jeremie G, Wright ED, Rotenberg BW. Revision rates after endoscopic sinus surgery: a recurrence analysis. Ann Otol Rhinol Laryngol. 2011;120(3):162-166.
  14. Head K, Chong LY, Hopkins C, Philpott C, Burton MJ, Schilder AGM. Short-course oral steroids alone for chronic rhinosinusitis. Cochrane Database Syst Rev. 2016;4:CD011991.
  15. Fokkens WJ, Lund VJ, Mullol J, et al. European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl. 2012;50(23):1-298.
  16. Vaidyanathan S, Barnes M, Williamson P, Hopkinson P, Donnan PT, Lipworth B. Treatment of chronic rhinosinusitis with nasal polyposis with oral steroids followed by topical steroids. Ann Intern Med. 2011;154(5):293-302.
  17. Van Zele T, Holtappels G, Gevaert P, Bachert C. Differences in initial immunoprofiles between recurrent and nonrecurrent chronic rhinosinusitis with nasal polyps. Am J Rhinol Allergy. 2014;28(3):192-198.
  18. Philpott C, Hopkins C, Erskine S,et al. The burden of revision sinonasal surgery in the UK—data from the Chronic Rhinosinusitis Epidemiology Study (CRES): a cross-sectional study. BMJ Open 2015;5:e006680. doi:10.1136/bmjopen-2014-006680
  19. Wenzel SE. Emergence of biomolecular pathways to define novel asthma phenotypes: type-2 immunity and beyond. Am J Respir Cell Mol Biol. 2016;55(1):1-4.
  20. Ray A, Raundhal M, Oriss TB, Ray P, Wenzel SE. Current concepts of severe asthma. J Clin Invest. 2016;126(7):2394-2403.