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
Work absenteeism and reduced productivity
Current medical and surgical therapy for
CRSwNP may provide short-term benefits13
A short course of oral corticosteroids may be beneficial for patients; however, the benefit is unlikely to
Side effects with long-term exposure may limit their potential as a chronic therapy
Surgery aims to remove nasal obstruction, improving sinus ventilation and access for topical
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
Chaaban MR, Walsh EM, Woodworth BA. Epidemiology and differential diagnosis of nasal polyps. Am J Rhinol
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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.
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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.
Schleimer RP. Immunopathogenesis of chronic rhinosinusitis and nasal polyposis. Annu Rev Pathol. 2017;12:331-357. doi:10.1146/annurev-pathol-052016-100401
Kato A. lmmunopathology of chronic rhinosinusitis. Allergol Int. 2015;64(2):121-130.
Bachert C, Pawankar R, Zhang L, et al. ICON: chronic rhinosinusitis. World Allergy Organ J.
Langdon C, Mullol J. Nasal polyps in patients with asthma: prevalence, impact, and management challenges. J
Asthma Allergy. 2016;9:45-53.
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.
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.
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
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.
Fokkens WJ, Lund VJ, Mullol J, et al. European position paper on rhinosinusitis and nasal polyps 2012.
Rhinol Suppl. 2012;50(23):1-298.
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.
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.
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.
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.
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