ARIA-ITALY multidisciplinary consensus on nasal polyposis and biological treatments

In the recent years, it was recognized that type-2 inflammation links many forms of nasal polyposis with severe asthma. Thus, some biological drugs developed for severe asthma appeared to exert an effect on nasal polyposis. So far, there are several trials supporting this concept; therefore, some monoclonal antibodies for severe asthma were assessed also in polyposis, with promising results. Since different specialists are involved in the management of nasal polyposis (eg, pulmonologists, ENT, allergists), it was felt that an educational and informative document was needed to better identify the indications of biologicals in nasal polyposis. We collected the main Italian Scientific Societies, and prepared (under the Allergic Rhinitis and its Impact on Asthma, ARIA) a document endorsed by all Societies, to provide a provisional statement for the future use of monoclonal antibodies as a medical treatment for polyposis. It is the first nationwide endorsed document on this aspect. The current pathogenic knowledge and the experimental evidence are herein reviewed, and some suggestions for a correct prescription and follow-up are provided.

Unstable-stable resonators with toroidal mirrors

A resonator with toroidal mirrors is described. This resonator behaves like an off-axis unstable confocal resonator in one transverse dimension and like an on-axis concave-convex stable resonator in the other orthogonal dimension. Some experimental results are reported for a fast flow high power cw-CO(2) laser whose transverse cross section is restricted in the stable-resonator direction. These cavities allow an output laser beam with a fully illuminated cross section which is well suited for focusing. Moreover, the fraction of the available laser power which may be concentrated in the central lobe of the focal plane intensity distribution is 2.5-4.5 times higher than other unstable resonators with similarly restricted modal volumes. Finally the alignment requirements are examined.

Efficacy of omalizumab in an atopic young adult with asthma and eosinophilic chronic rhinosinusitis with nasal polyps

OBJECTIVE

Chronic rhinosinusitis (CRS) presents a multifactorial etiology due to interactions between the immune host system and external agents. It can be classified into two phenotypes based on the presence or absence of polypoid neoformation (respectively CRSwNP and CRSsNP). According to EPOS2020, CRS is now classified into two endotypes, eosinophilic (ECRS) and non-eosinophilic (non-ECRS), based on eosinophil tissue count (more than 10 eosinophils per High Power Field, HPF).

CASE PRESENTATION

We present the case of a 31-year-old man affected by recalcitrant ECRSwNP and asthma.

RESULTS

He was treated with a combination of omalizumab and endoscopic sinus surgery. This combination led to a reduction in blood eosinophils, modified Lund-Kennedy endoscopic score, Lund-Mackay score, and Sino-Nasal Outcome Test (SNOT-22), almost 6 months after surgery.

CONCLUSIONS

In this clinical case, omalizumab regulated nasal symptoms for more than a year and with good control of the recalcitrant pattern when combined with ESS.