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Alska E, Łaszczych D, Napiórkowska-Baran K, Szymczak B, Rajewska A, Rubisz AE, Romaniuk P, Wrzesień K, Mućka N, Bartuzi Z. Advances in Biologic Therapies for Allergic Diseases: Current Trends, Emerging Agents, and Future Perspectives. J Clin Med 2025; 14:1079. [PMID: 40004611 PMCID: PMC11856668 DOI: 10.3390/jcm14041079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Revised: 01/23/2025] [Accepted: 02/04/2025] [Indexed: 02/27/2025] Open
Abstract
Biologic therapies have revolutionized the treatment of severe allergic diseases, including asthma, atopic dermatitis (AD), chronic spontaneous urticaria (CSU), chronic rhinosinusitis with nasal polyps (CRSwNP), eosinophilic gastrointestinal diseases (EGIDs), and allergic rhinitis (AR). These molecularly targeted agents provide significant benefits for patients unresponsive to conventional treatments by addressing underlying immune mechanisms, particularly type 2 inflammation driven by cytokines such as IL-4, IL-5, and IL-13. Recent advancements include biologics targeting alarmins like thymic stromal lymphopoietin (TSLP) and IL-33, which may address both type 2 and non-type 2 inflammation, broadening their therapeutic scope. Despite their effectiveness, biologics remain expensive, posing socioeconomic challenges, and there are concerns regarding long-term safety and inter-individual variability in responses. Promising innovations such as bispecific antibodies and ultra-long-acting agents are under investigation, alongside digital health tools like remote biomarker monitoring and AI-driven decision support systems, which aim to enhance personalized care. However, disparities in access, particularly for underserved populations, underscore the need for policy reforms and affordable biosimilars. This review synthesizes recent findings and emerging trends, highlighting the evolving role of biologics in transforming allergic disease management and offering insights into future research directions.
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Affiliation(s)
- Ewa Alska
- Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (E.A.); (Z.B.)
| | - Dariusz Łaszczych
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (D.Ł.); (B.S.); (A.R.); (A.E.R.); (P.R.); (K.W.); (N.M.)
| | - Katarzyna Napiórkowska-Baran
- Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (E.A.); (Z.B.)
| | - Bartłomiej Szymczak
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (D.Ł.); (B.S.); (A.R.); (A.E.R.); (P.R.); (K.W.); (N.M.)
| | - Alicja Rajewska
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (D.Ł.); (B.S.); (A.R.); (A.E.R.); (P.R.); (K.W.); (N.M.)
| | - Aleksandra Ewa Rubisz
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (D.Ł.); (B.S.); (A.R.); (A.E.R.); (P.R.); (K.W.); (N.M.)
| | - Paulina Romaniuk
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (D.Ł.); (B.S.); (A.R.); (A.E.R.); (P.R.); (K.W.); (N.M.)
| | - Katarzyna Wrzesień
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (D.Ł.); (B.S.); (A.R.); (A.E.R.); (P.R.); (K.W.); (N.M.)
| | - Natalia Mućka
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (D.Ł.); (B.S.); (A.R.); (A.E.R.); (P.R.); (K.W.); (N.M.)
| | - Zbigniew Bartuzi
- Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (E.A.); (Z.B.)
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Soltanipur M, Rohani Bastami M, Shahshenas S, Ghorbanniadelavar Z, Barouh A, Shadmand A, Karimi Nemch M, Yarmohammadi H, Siadat SD, Jalali Nadoushan M. Expression of Proliferating Cell Nuclear Antigen (PCNA) in Nasal Polyp: A Systematic Review and Meta-analysis. Indian J Otolaryngol Head Neck Surg 2025; 77:608-619. [PMID: 40066409 PMCID: PMC11890497 DOI: 10.1007/s12070-024-05172-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 10/24/2024] [Indexed: 05/10/2025] Open
Abstract
UNLABELLED Nasal polyp (NP) is a pathological benign mass that affects the nasal cavity and paranasal sinuses. This lesion is occasionally associated with chronic rhinosinusitis (CRS), which is named chronic rhinosinusitis with nasal polyps (CRSwNP). Proliferating cell nuclear antigen (PCNA) indicates abnormal cell proliferation which may help assess the nasopharyngeal lesions and upper airway cancers. This study aimed to examine the PCNA expression in NP tissue. This study was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A thorough search using relevant keywords was performed on the electronic database to identify studies examining the PCNA expression in NP. Meta-analysis on pooled single group proportion and means of PCNA expression was conducted by the metamean and metaprop functions in R software (version 4.4.0). Quality assessment was done according to the Joanna Briggs Institute (JBI) checklist. Ten articles were included in this study. The PCNA expression in NP was higher than in normal nasal mucosa (NNM), while its expression in NP was lower than in inverted papilloma (IP). The mean percentage of PCNA expression in NP was 15.73% (95%-CI[2.87-28.58]) with considerable heterogeneity (I 2 = 97%[96-98%],p-value < 0.01). Based on a cutoff staining (> 5%), 64% of NP samples were PCNA-positive (95%-CI[42-81%]) with high heterogeneity (I 2 = 76%[47-89%], p-value < 0.01). NP tissue has a relatively high expression of the PCNA oncoprotein based on the immunohistochemistry (IHC) staining. Although more than half of NP samples were positive for PCNA, still the mean expression of this marker in NP was lower than in IP tissue. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s12070-024-05172-y.
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Affiliation(s)
- Masood Soltanipur
- Quality of Life Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
- General Practitioner (GP), Avicenna Hospital, Tehran, Iran
| | | | - Sina Shahshenas
- Student Research Committee, Faculty of Medicine, Shahed University, Tehran, Iran
| | | | - Alireza Barouh
- Student Research Committee, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Alireza Shadmand
- Faculty of Economics and Social Sciences, Heidelberg University, Heidelberg, Germany
| | | | - Hossein Yarmohammadi
- Quality of Life Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Seyed Davar Siadat
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
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Fiorentino V, Martini M, Galletti C, Pizzimenti C, Franchina M, Ieni A, Fadda G, Galletti B, Tuccari G. The Morphology of Nasal Polyps in Different Age Groups: Histopathological Features. J Pers Med 2024; 14:414. [PMID: 38673041 PMCID: PMC11051558 DOI: 10.3390/jpm14040414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Nasal polyps (NPs) represent the end-stage manifestation of chronic rhinosinusitis (CRS), a relatively common pathological condition encountered in all ages of life. METHODOLOGY The aim of our study was to evaluate the histological features and inflammatory cellular components of NPs in a retrospective cohort (143 cases) of pediatric, adult and elderly populations in order to discuss the possible morphological age-related differences statistically documented. RESULTS In the pediatric group, the inflammatory infiltrate presented many eosinophils mixed with lymphocytes, while in the adult population, lymphocytes and plasma cells were mainly evident, frequently with a perivascular distribution or with the formation of subepithelial lymphoid nodules. In the elderly population, inflammation was less evident and was associated with cavernous-like angecthatic structures with thrombotic stratification. Nearly all morphological findings exhibited statistically significant values among differently aged subgroups. CONCLUSIONS Our results support the presence of histological specificities of NPs at different ages of life, providing new insight into the etiopathogenesis of NPs. The future role of biological therapies, mainly in cases refractory to already available standard medical and surgical treatments, may be analyzed by a prospective study using a larger cohort with a long-term evaluation also in relation to a possible relapse.
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Affiliation(s)
- Vincenzo Fiorentino
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Maurizio Martini
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Cosimo Galletti
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Cristina Pizzimenti
- Dipartimento di Scienze Biomediche, Odontoiatriche e Delle Immagini Morfologiche e Funzionali, Università Degli Studi di Messina, 98122 Messina, Italy;
| | - Mariausilia Franchina
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Antonio Ieni
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Guido Fadda
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Bruno Galletti
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
| | - Giovanni Tuccari
- Dipartimento di Patologia Umana Dell’adulto e Dell’età Evolutiva Gaetano Barresi, Università Degli Studi di Messina, 98122 Messina, Italy; (M.M.); (C.G.); (M.F.); (A.I.); (G.F.); (B.G.); (G.T.)
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Galletti C, Ragusa M, Sireci F, Ciodaro F, Barbieri MA, Giunta G, Grigaliute E, Immordino A, Lorusso F, Dispenza F, Freni F, Galletti F, Gallina S, La Mantia I, Galletti B. Dupilumab in chronic rhinosinusitis with nasal polyps: Real life data in a multicentric Sicilian experience. Am J Otolaryngol 2024; 45:104106. [PMID: 37948824 DOI: 10.1016/j.amjoto.2023.104106] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/18/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness and safety of dupilumab during the first year of treatment in a real-life setting, focusing on improvement in nasal polyp score (NPS) as well as specific symptoms, quality of life and olfactory function. METHODOLOGY/PRINCIPAL A multicentric observational cohort study was carried out. A total of 170 patients were enrolled in the Otorhinolaryngology Unit of the three University Hospitals and considered for dupilumab therapy. All recorder characteristics were age (at the first dupilumab application visit), sex, smoke habits, previous local and systemic corticosteroid therapy, history of endoscopic sinus surgery, number of previous endoscopic sinus surgery, concomitant asthma, history of an allergic condition, immunoglobulin E (IgE), allergy to nonsteroidal anti-inflammatory drugs (NSAIDs), Aspirin Exacerbated Respiratory Disease (AERD), other comorbidities associated, blood eosinophils, nasal polyp score, sinonasal outcome test 22 (SNOT 22), sniffin' stick test, the start date of dupilumab therapy and number of doses of dupilumab and eventually, Dupilumab's adverse events related to administration. The Wilcoxon test for dependent samples was performed to compare variables. Statistical significance was assumed for p values < 0.05. RESULTS A statistically significant reduction in SNOT-22 and NPS was shown at the 6th and 12th month compared to baseline values (p < 0.001 for both comparisons). A statistically significant increase value at the Sniffin' sticks test was shown in the 6th and 12th month compared to baseline values (p < 0.001 for both comparisons). At the 12-month follow-up, according to EUFOREA indications, all patients were considered to remain in treatment with dupilumab and continued the treatment because of a reduced NPS, improved quality of life and a reduced need for system corticosteroids. Dupilumab seemed to be well tolerated by all patients. Any adverse effect of the drug led to the quit of biological treatment. CONCLUSIONS This multi-centric real-life study supported the effectiveness of dupilumab as an add-on therapy to intranasal corticosteroids in patients with severe uncontrolled CRSwNP in improvement of quality of life, severity of symptoms, polyp size reduction and smell function. Furthermore, our data support the safety profile of monoclonal therapy with dupilumab.
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Affiliation(s)
- Cosimo Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
| | - Martina Ragusa
- Department of Medical-Surgical Sciences and Advanced Technologies, E.N.T. Unit, P.O. "G. Rodolico", University of Catania, Catania, Italy
| | - Federico Sireci
- Otorhinolaryngology Section, Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Via del Vespro 129, 133, 90127 Palermo, Italy
| | - Francesco Ciodaro
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy
| | | | - Giorgia Giunta
- Department of Medical-Surgical Sciences and Advanced Technologies, E.N.T. Unit, P.O. "G. Rodolico", University of Catania, Catania, Italy
| | - Egle Grigaliute
- Department of Medical-Surgical Sciences and Advanced Technologies, E.N.T. Unit, P.O. "G. Rodolico", University of Catania, Catania, Italy
| | - Angelo Immordino
- Otorhinolaryngology Section, Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Via del Vespro 129, 133, 90127 Palermo, Italy
| | - Francesco Lorusso
- Otorhinolaryngology Section, Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Via del Vespro 129, 133, 90127 Palermo, Italy
| | - Francesco Dispenza
- Otorhinolaryngology Section, Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Via del Vespro 129, 133, 90127 Palermo, Italy
| | - Francesco Freni
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy
| | - Francesco Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy
| | - Salvatore Gallina
- Otorhinolaryngology Section, Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Via del Vespro 129, 133, 90127 Palermo, Italy
| | - Igo La Mantia
- Department of Medical-Surgical Sciences and Advanced Technologies, E.N.T. Unit, P.O. "G. Rodolico", University of Catania, Catania, Italy
| | - Bruno Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy
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Galletti C, Barbieri MA, Ciodaro F, Freni F, Galletti F, Spina E, Galletti B. Effectiveness and Safety Profile of Dupilumab in Chronic Rhinosinusitis with Nasal Polyps: Real-Life Data in Tertiary Care. Pharmaceuticals (Basel) 2023; 16:ph16040630. [PMID: 37111387 PMCID: PMC10141684 DOI: 10.3390/ph16040630] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/12/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by a type 2 pattern of inflammation resulting in the production of some cytokines. Dupilumab radically changes the treatment of CRSwNP, but, considering its recent approval, it may be useful to evaluate its safety profile in a real-world setting. This work aimed to prospectively highlight the effectiveness and safety profile of dupilumab in patients with CRSwNP enrolled in the Otorhinolaryngology Unit of the University Hospital of Messina. An observational cohort study was carried out considering all patients treated with dupilumab. A descriptive analysis was conducted reporting all demographic characteristics, endoscopic evaluations, and symptom conditions. A total of 66 patients were treated with dupilumab, but three patients were excluded due to a lack of adherence during the observational period. A statistically significant reduction in the Sino-Nasal Outcome Test 22 (SNOT-22) and nasal polyps score (NPS) was shown at the 6th and 12th months compared to baseline values (SNOT-22, -37 and -50, p < 0.001 for both comparisons; NPS, -3 and -4, p < 0.001 for both comparisons). During the follow-up, eight patients (12.7%) had a reaction at the site of injection, and seven (11.1%) had transient hypereosinophilia. Given the optimal treatment response and the minimal adverse effects observed, clinicians should consider dupilumab a safe and effective treatment. Further studies are necessary to better understand the long-term effects.
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Affiliation(s)
- Cosimo Galletti
- Department of Adult and Developmental Human Pathology "Gaetano Barresi", University of Messina, 98100 Messina, Italy
| | | | - Francesco Ciodaro
- Department of Adult and Developmental Human Pathology "Gaetano Barresi", University of Messina, 98100 Messina, Italy
| | - Francesco Freni
- Department of Adult and Developmental Human Pathology "Gaetano Barresi", University of Messina, 98100 Messina, Italy
| | - Francesco Galletti
- Department of Adult and Developmental Human Pathology "Gaetano Barresi", University of Messina, 98100 Messina, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | - Bruno Galletti
- Department of Adult and Developmental Human Pathology "Gaetano Barresi", University of Messina, 98100 Messina, Italy
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