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Antosz K, Batko J, Błażejewska M, Gawor A, Sleziak J, Gomułka K. Insight into IL-5 as a Potential Target for the Treatment of Allergic Diseases. Biomedicines 2024; 12:1531. [PMID: 39062104 PMCID: PMC11275030 DOI: 10.3390/biomedicines12071531] [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: 05/31/2024] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
Interleukin-5 functions as a B-cell differentiation factor, but more importantly, in the context of this review, it plays a variety of roles in eosinophil biology, including eosinophil differentiation and maturation in the bone marrow, and facilitates eosinophil migration to tissue sites, usually in the context of an allergic reaction. Given the availability of selective anti-IL-5 drugs such as mepolizumab and reslizumab, as well as the IL-5 receptor antagonist benralizumab, it is worth investigating whether they could be used in some cases of allergic disease. Asthma has a well-documented involvement of IL-5 in its pathophysiology and has clear benefits in the case of anti-IL-5 therapy; therefore, current knowledge is presented to provide a reference point for the study of less-described diseases such as atopic dermatitis, chronic rhinosinusitis, chronic spontaneous urticaria, and its association with both IL-5 and anti-IL-5 treatment options. We then review the current literature on these diseases, explain where appropriate potential reasons why anti-IL-5 treatments are ineffective, and then point out possible future directions for further research.
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Affiliation(s)
- Katarzyna Antosz
- Student Research Group of Internal Medicine and Allergology, Faculty of Medicine, Wroclaw Medical University, 50-368 Wroclaw, Poland; (K.A.); (J.B.); (M.B.); (A.G.); (J.S.)
| | - Joanna Batko
- Student Research Group of Internal Medicine and Allergology, Faculty of Medicine, Wroclaw Medical University, 50-368 Wroclaw, Poland; (K.A.); (J.B.); (M.B.); (A.G.); (J.S.)
| | - Marta Błażejewska
- Student Research Group of Internal Medicine and Allergology, Faculty of Medicine, Wroclaw Medical University, 50-368 Wroclaw, Poland; (K.A.); (J.B.); (M.B.); (A.G.); (J.S.)
| | - Antoni Gawor
- Student Research Group of Internal Medicine and Allergology, Faculty of Medicine, Wroclaw Medical University, 50-368 Wroclaw, Poland; (K.A.); (J.B.); (M.B.); (A.G.); (J.S.)
| | - Jakub Sleziak
- Student Research Group of Internal Medicine and Allergology, Faculty of Medicine, Wroclaw Medical University, 50-368 Wroclaw, Poland; (K.A.); (J.B.); (M.B.); (A.G.); (J.S.)
| | - Krzysztof Gomułka
- Department of Internal Medicine, Pneumology and Allergology, Faculty of Medicine, Wroclaw Medical University, 50-368 Wroclaw, Poland
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Anselmo-Lima WT, Romano FR, Tamashiro E, Roithmann R, Dinarte VRP, Piltcher OB, Miyake MM, Fornazieri MA, Nakanishi M, Bezerra TFP, Dolci RLL, Mello JF, Lessa MM, Voegels RL, Kosugi EM, Sakano E, Valera FCP. Brazilian guideline for the use of immunobiologicals in chronic rhinosinusitis with nasal polyps ‒ 2024 update. Braz J Otorhinolaryngol 2024; 90:101394. [PMID: 38367543 PMCID: PMC10879704 DOI: 10.1016/j.bjorl.2024.101394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION Biologics targeting type 2 inflammation have revolutionized the way we treat patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Particularly in severe and difficult-to-control cases, these drugs have provided a new reality for these patients, allowing for the effective and safe treatment of extensive diseases that were not completely managed with the typical strategy of surgery and topical medications. OBJECTIVES The experience achieved with the approval of these medications by ANVISA for use in CRSwNP and the knowledge obtained regarding outcomes, adverse effects, and the ideal patient profile prompted the update of the previously published guideline, with a detailed review of the most recent scientific literature, the personal experiences of experts, and the adaptation to the reality of the Brazilian healthcare system, both public and private. RESULTS We proposed a new eligibility criterion for biologics in patients with CRSwNP based on four pillars of indication: the impact of the disease on the patient's life, whether in the presence of specific symptoms or in overall quality of life; the extent of sinonasal disease; the presence of type 2 comorbidities, considering other associated diseases that may also benefit from anti-T2 biologics, and the presence of biomarkers to define type 2 inflammation, especially those associated with worse disease prognoses. CONCLUSIONS This innovative and pioneering method has two major advantages. First, it ensures a comprehensive evaluation of patients; second, it is flexible, as advancements in our understanding of the disease and changes in cost-effectiveness can be addressed by simply adjusting the required score for indication, without the need to modify the entire evaluation scheme.
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Affiliation(s)
- Wilma T Anselmo-Lima
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil.
| | - Fabrizio R Romano
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil; Universidade de São Paulo (FMRP-USP), Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Edwin Tamashiro
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | | | | | - Otavio B Piltcher
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (FAMED-UFRGS), Departamento de Oftalmologia e Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Marcel M Miyake
- Universidade de São Paulo (FMRP-USP), Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil; Santa Casa de Misericórdia, Hospital de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Marco A Fornazieri
- Universidade Estatual de Londrina, Londrina, PR, Brazil; Pontifícia Universidade Católica do Paraná (PUCPR), Câmpus Londrina, Londrina, PR, Brazil
| | - Marcio Nakanishi
- Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação, Brasilia, DF, Brazil
| | | | | | - João F Mello
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcus M Lessa
- Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Richard L Voegels
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eduardo M Kosugi
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Eulalia Sakano
- Universidade Estadual Paulista, Faculdade de Ciências Médicas, Departamento de Oftalmologia/Otorrinolaringologia, Campinas, SP, Brazil
| | - Fabiana C P Valera
- Universidade de São Paulo (FMRP-USP), Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
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Shah B, Kajal S, Bhalla AS, Madan K, Viswanathan GK, Thakar A, Sikka K, Bairwa M, Verma H. Prolonged Itraconazole Therapy as Sole Treatment for Patients with Allergic Fungal Rhinosinusitis. Laryngoscope 2024; 134:545-551. [PMID: 37377280 DOI: 10.1002/lary.30841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/31/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Currently, the mainstay of treatment for allergic fungal rhinosinusitis (AFRS) is surgical debridement along with topical or systemic steroids. However, prolonged systemic steroid therapy comes with side effects and is also sometimes contraindicated. Systemic antifungals have been used earlier as an adjunct to steroids or in refractory cases, but they have not been used as the sole primary treatment. OBJECTIVE To study the effectiveness of sole Itraconazole therapy in patients with AFRS by comparison of clinical, radiological, and biochemical parameters before and after treatment. METHODS Thirty-four patients diagnosed with localized sino-nasal AFRS were recruited and started on the tablet Itraconazole 200 mg orally twice daily for 3 months with q2weekly monitoring of liver function tests. The baseline clinical, radiological, and biochemical parameters were then compared with those after completion of 3 months of Itraconazole therapy. RESULTS There was significant difference between all the parameters-clinical: SNOT-22 score (p < 0.001) and Meltzer endoscopy score (p < 0.001), radiological: Lund-Mackay score (p = 0.004) and 20-point CT score (p = 0.002), and biochemical: serum total IgE (p < 0.001), Aspergillus-specific IgE (p < 0.001), and absolute eosinophil count (p < 0.001). The clearance of the disease was more in anterior sinuses than the posterior ones. CONCLUSION Prolonged Itraconazole can be given as sole therapy in AFRS, especially in patients for whom steroids are contraindicated or in those who are awaiting surgery. It can result in symptomatic and radiological improvement, but surgery still remains the definitive treatment option for AFRS for complete clearance of disease. LEVEL OF EVIDENCE 3 Laryngoscope, 134:545-551, 2024.
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Affiliation(s)
- B Shah
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - S Kajal
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - A S Bhalla
- Department of Radiodiagnosis, AIIMS, New Delhi, India
| | - K Madan
- Department of Pulmonary Medicine, AIIMS, New Delhi, India
| | - G K Viswanathan
- Department of Haematology and Oncology, AIIMS, New Delhi, India
| | - A Thakar
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - K Sikka
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M Bairwa
- Department of Community Medicine, AIIMS, New Delhi, India
| | - H Verma
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Papacharalampous GX, Constantinidis J, Fotiadis G, Zhang N, Bachert C, Katotomichelakis M. Chronic rhinosinusitis with nasal polyps (CRSwNP) treated with omalizumab, dupilumab, or mepolizumab: A systematic review of the current knowledge towards an attempt to compare agents' efficacy. Int Forum Allergy Rhinol 2024; 14:96-109. [PMID: 37394893 DOI: 10.1002/alr.23234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The heterogeneity of existing studies, along with the fact that there are no published head-to-head trials, are the main reasons for the lack of guidelines regarding the selection of the proper biologic in treatment of chronic rhinosinusitis (CRS) with nasal polyps. The aim of this study is to summarize the current knowledge regarding the efficacy of omalizumab, dupilumab, and mepolizumab in CRS treatment. We also attempt to proceed to an indirect comparison of the agents and try to answer the tricky question: which agent to select and why? METHODS An extensive search in English literature was conducted in PubMed/Medline, Embase, Google Scholar, and Cochrane Database/Library. Eligibility criteria included papers with full text published in English, adult population studies, clearly described intervention protocol, and documented primary and secondary outcomes. RESULTS The studies included numbered 37. All agents provided significant improvement in polyp size, sinuses opacification, severity of symptoms, need for surgery and systemic corticosteroids use. Analysis of available systematic reviews, meta-analyses and indirect treatment comparison studies showed that dupilumab appeared to be the most beneficial agent, in terms of primary and secondary outcomes. However, these results are of relatively low level of evidence due to several methodological limitations. CONCLUSIONS Although the present analysis showed a moderate supremacy of dupilumab, there is still no evidence-based answer to the question "which biologic agent is the most effective in CRS treatment?" Improved statistical methodology, head-to-head trials, and real-life studies could lead to more robust conclusions, establishing the real role of the specific biologic agents.
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Affiliation(s)
| | - Jannis Constantinidis
- 1st Department of Otorhinolaryngology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Fotiadis
- Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nan Zhang
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Münster, Münster, Germany
| | - Claus Bachert
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Münster, Münster, Germany
- First Affiliated Hospital, Sun Yat-Sen University, International Airway Research Center, Guangzhou, China
- Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Michael Katotomichelakis
- Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Gill AS, Alt JA, Detwiller KY, Rowan NR, Gray ST, Hellings PW, Joshi SR, Lee JT, Soler ZM, Tan BK, Taylor-Cousar JL, Wise SK, Wu TJ, Beswick DM. Management paradigms for chronic rhinosinusitis in individuals with asthma: An evidence-based review with recommendations. Int Forum Allergy Rhinol 2023; 13:1758-1782. [PMID: 36579899 DOI: 10.1002/alr.23130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite the significant morbidity associated with chronic rhinosinusitis (CRS) in individuals with asthma (CRSwA), there is a paucity of codified, evidence-based management strategies for CRS in this population. METHODS Using PubMed, Embase, and Cochrane Review Databases, a systematic review was performed covering management strategies for CRSwA. A total of 5903 articles were screened, and 70 were included for full-text analysis. After application of exclusion criteria, 53 articles comprised the qualitative synthesis. The level of evidence was graded and benefit-harm assessments, as well as value judgment and recommendations, were provided RESULTS: Strong evidence confirms the benefit of oral and topical medications on sinonasal-specific outcomes in individuals with CRSwA; there is low-grade evidence demonstrating that these agents improve lung function and/or asthma control. Moderate to strong evidence suggests that endoscopic sinus surgery (ESS) improves both sinonasal- and asthma-specific quality of life. Although there is insufficient to low evidence to indicate that ESS improves pulmonary function in this population, data indicate a positive impact of this intervention on asthma control. Biologic medications strongly improve both subjective and objective sinonasal- and asthma-specific outcomes. CONCLUSION Evidence supports managing CRS in individuals with CRSwA in a stepwise fashion, starting with traditional nonbiologic oral and topical medication, and escalating to second-line treatments, such as ESS and biologics. Optimal treatment of individuals who have CRSwA often requires concurrent, directed management of asthma, as not all CRS interventions impact asthma status.
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Affiliation(s)
- Amarbir S Gill
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeremiah A Alt
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Kara Y Detwiller
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and neck Surgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stacey T Gray
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Peter W Hellings
- Department of Otorhinolaryngology, University Hospitals Leuven, and Department of Otorhinolaryngology, Upper Airway Research Laboratory, University of Ghent, Ghent, Belgium
| | - Shyam R Joshi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Jivianne T Lee
- Department of Otolaryngology - Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Zach M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bruce K Tan
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer L Taylor-Cousar
- National Jewish Health, Departments of Internal Medicine and Pediatrics, Pulmonary Divisions, Denver, Colorado, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Tara J Wu
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel M Beswick
- Department of Otolaryngology - Head and Neck Surgery, University of California, Los Angeles, California, USA
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Mirza AA, Abdulazeem HM, Al-Sayed AA, Alandejani TA, Shawli HY, Thompson JY, Alhaddad MH, Varshney R, Zawawi F. Biologic Therapies in Chronic Rhinosinusitis with Nasal Polyposis: Overview of Systematic Reviews and Updated Systematic Review. Indian J Otolaryngol Head Neck Surg 2023; 75:650-660. [PMID: 37206723 PMCID: PMC10188799 DOI: 10.1007/s12070-022-03144-8] [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: 09/01/2021] [Accepted: 08/19/2022] [Indexed: 05/21/2023] Open
Abstract
Objectives Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a highly prevalent and challenging disease to manage. Several systematic reviews (SRs) have been carried out to evaluate the efficacy and safety of biologic therapies. We aimed to evaluate the current and available evidence of the biologics in treating CRSwNP. Data Source Systematic Review of three electronic databases. Review Methods Following the PRISMA Statement, the authors explored three main databases through February 2020 for pertinent SRs and meta-analyses (MAs) as well as experimental and observational studies. A Measurement Tool to Assess Systematic Reviews Version-2 (AMSTAR-2), was employed to evaluate the quality of methodology of SRs and MAs. Results A Total of five SRs were included in this overview. The AMSTAR-2 final summary was moderate to critically low. Although conflicting findings were reported, anti-immunoglobulin E (Anti-IgE) and anti-interleukin-4 (Anti-IL-4) were superior to placebo for improving total nasal polyp (NP) score, particularly in patients with asthma. Findings of the included reviews revealed that both sinus opacification and the Lund-Mackay (LMK) total scores significantly improved after biologics use. Subjective quality-of-life (QoL) assessment provided by general and specific questionnaires illustrated favorable results of biologics for CRSwNP, whereas no significant adverse events were reported. Conclusion The current findings support the use of biologics for CRSwNP patients. However, the evidence for their use in such patients should be cautiously adopted because of the questionable evidence. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03144-8.
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Affiliation(s)
- Ahmad A. Mirza
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Ahmed A. Al-Sayed
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS Canada
| | - Talal A. Alandejani
- Department of Surgery-Division of Otolaryngology, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Surgery-Division of Otolaryngology, Ministry of the National Guard – Health Affairs, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Hatim Y. Shawli
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Jacqueline Y. Thompson
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mohammed H. Alhaddad
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rickul Varshney
- Department of Otolaryngology, Head and Neck Surgery, McGill University, Montreal, Canada
| | - Faisal Zawawi
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Koski RR, Hill L, Taavola K. Efficacy and Safety of Biologics for Chronic Rhinosinusitis With Nasal Polyps. J Pharm Technol 2022; 38:289-296. [PMID: 36046351 PMCID: PMC9420916 DOI: 10.1177/87551225221105749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
Objective: To review published literature for biologic treatment of nasal polyps. Data Sources: PubMed search performed on February 16, 2022, using search terms: biologics, benralizumab, dupilumab, mepolizumab, omalizumab, or reslizumab AND nasal polyps, nasal polyposis, or chronic rhinosinusitis with nasal polyposis (CRSwNP). Inclusion criteria were English language, published randomized controlled trials, post hoc analyses, and meta-analyses evaluating biologics for nasal polyposis, with or without comorbid asthma, and no date limits. Additional studies were found through references of primary and tertiary literature. Study Selection and Data Extraction: Nineteen studies, including 8 randomized controlled trials, 2 meta-analyses, and 9 post hoc analyses, examined the efficacy and safety of biologics for nasal polyposis. Agents studied included benralizumab, dupilumab, mepolizumab, omalizumab, and reslizumab. Studies had similar inclusion (refractory and recurrent CRSwNP) and exclusion criteria. All studies included the use of an intranasal corticosteroid (mometasone or fluticasone) in addition to the biologic or placebo. The most commonly studied primary endpoint was change in endoscopic nasal polyp score. Data Synthesis: All studies, post hoc analyses, and meta-analyses found improvement in endoscopic, clinical, and/or radiographic endpoints with benralizumab, dupilumab, mepolizumab, omalizumab, or reslizumab in patients with CRSwNP with or without comorbid asthma. Dupilumab has the most published data. Dupilumab, mepolizumab, and omalizumab are the only biologics currently Food and Drug Administration-approved for CRSwNP. Conclusion: Biologics are beneficial for treating nasal polyps with or without comorbid asthma. The choice depends on patient and provider preference and insurance coverage.
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Affiliation(s)
- Renee R. Koski
- Pharmacy Practice, College of Pharmacy, Ferris State University, Big Rapids, MI, USA
- UP Health System Marquette, Marquette, MI, USA
| | - Luke Hill
- UP Health System Marquette, Marquette, MI, USA
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Ruggiero R, Motta G, Massaro G, Rafaniello C, Della Corte A, De Angelis A, Capuano A, Motta G, Rossi F. Pharmacological, Technological, and Digital Innovative Aspects in Rhinology. FRONTIERS IN ALLERGY 2021; 2:732909. [PMID: 35387050 PMCID: PMC8974665 DOI: 10.3389/falgy.2021.732909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022] Open
Abstract
Innovation refers to the introduction of a product, a process, a service or a solution resulting in something new or significantly improved compared to the already available alternatives. In the clinical context, it is strictly related to the identification of a new added value in terms of quality, therapeutic efficacy and safety. Over the years several innovative approaches have been introduced in the clinical practice, revolutionizing the treatment and the management of important rhinologic conditions. Innovative tools, including new drugs, biomaterials, and mobile applications seem to be able to improve the clinical outcomes and the quality of life of many patients affected by (often relapsing) rhinologic diseases. Among the main modern pharmacological innovations, mention must be made of the biological drugs like monoclonal antibodies (mAbs). Recently, new mAbs have been introduced and investigated as useful arms in the treatment of some inflammatory/infectious or oncological diseases affecting the nasal cavities and paranasal sinuses. The already approved or still investigated mAbs work inhibiting different type 2 inflammation pathways, including those mediated by IgE (omalizumab), IL-4/IL-13 (dupilumab), and IL-5 (mepolizumab). Moreover, considering the higher expression of PD-L1 in nasopharyngeal carcinoma, the use of PD-1 inhibitors, such as nivolumab, or a dual CTLA-4/PD-1 blockade (ipilimumab plus nivolumab) appear to be an effective strategy for the treatment of this cancer form. The implants with bio-absorbable biomaterials represent new interesting available technological innovations. Moreover, advanced technologies such as the artificial intelligence, the machine learning as well as the augmented or virtual reality have also proved useful in rhinologic field with main impacts on precision medicine and surgery. Finally, the development and use of mobile-Health tools represent a winning strategy in monitoring of the therapy success, safety and tolerability as well as the progress of chronic disease including chronic rhinosinusitis with nasal polyps. Supporting the research of innovative tools and strategies (including pharmacological, technologic, or digital ones) is essential to improve the management of chronic diseases that significantly affect the patients' quality of life.
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Affiliation(s)
- Rosanna Ruggiero
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Naples, Italy
- *Correspondence: Rosanna Ruggiero
| | - Giovanni Motta
- Department of Mental Health and Public Medicine, Section of Otorhinolaryngology—Head and Neck Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giuseppe Massaro
- Department of Mental Health and Public Medicine, Section of Otorhinolaryngology—Head and Neck Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Concetta Rafaniello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Alberto Della Corte
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonella De Angelis
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gaetano Motta
- Department of Mental Health and Public Medicine, Section of Otorhinolaryngology—Head and Neck Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesco Rossi
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Lombardi C, Asero R, Bagnasco D, Blasi F, Bonini M, Bussi M, Canevari RF, Canonica GW, Castelnuovo P, Cecchi L, Cosmi L, Gelardi M, Heffler E, Indinnimeo L, Landi M, Licari A, Liotta F, Macchi A, Malvezzi L, Marseglia G, Micheletto C, Musarra A, Peroni D, Piacentini G, Poletti V, Richeldi L, Santoni A, Schiappoli M, Senna G, Vaghi A, Villani A, Passalacqua G. ARIA-ITALY multidisciplinary consensus on nasal polyposis and biological treatments. World Allergy Organ J 2021; 14:100592. [PMID: 34786034 PMCID: PMC8573187 DOI: 10.1016/j.waojou.2021.100592] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/05/2021] [Accepted: 09/06/2021] [Indexed: 12/22/2022] Open
Abstract
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.
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Affiliation(s)
- Carlo Lombardi
- Unit of Allergology, Clinical Immunology & Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, MI, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico S.Martino, University of Genoa, Italy
| | - Francesco Blasi
- Dipartimento Fisiopatologia Medico-chirurgica e Trapianti Università di Milano, IRCCS Fondazione Cà Granda, Policlinico di Milano, Italy
| | - Matteo Bonini
- Dipartimento di Scienze Cardiovascolari e Toraciche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Mario Bussi
- Unità Operativa di Otorinolaringoiatria Ospedale Universitario I.R.C.C.S. San Raffaele, Milan, Italy
| | - Rikki F. Canevari
- Dipartimento DISC Clinica Otorinolaringoiatra IRCCS Policlinico San Martino, Università di Genova, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paolo Castelnuovo
- DBSV, Clinica ORL, Università Insubria, ASST-settelaghi, HNS&FDR Center, Varese, Italy
| | - Lorenzo Cecchi
- SOS Allergologia e Immunologia Clinica Prato, USL Toscana Centro, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Matteo Gelardi
- Clinica Otorinolaringoiatrica, Dipartimento di Medicina Clinica e Sperimentale, Università di Foggia, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luciana Indinnimeo
- Università degli Studi di Roma “Sapienza”, Direttore Scientifico di Area Pediatrica, Società Italiana di Pediatria, Italy
| | - Massimo Landi
- Pediatric National Healthcare System, Turin, Institute of Biomedical Research and Innovation Palermo, Italy
| | - Amelia Licari
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Francesco Liotta
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Alberto Macchi
- Clinica ORL, Asst Settelaghi Varese, Università degli Studi dell’ Insubria, Varese, Italy
| | - Luca Malvezzi
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical & Research Center, Rozzano, MI, Italy
| | - Gianluigi Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | | | - Antonino Musarra
- Servizio di Allergologia, Casa della Salute di Scilla, ASP di Reggio Calabria, Italy
| | - Diego Peroni
- Pediatrics, Dept. of Experimental Medicine, University of Pisa, Italy
| | - Giorgio Piacentini
- Dipartimento di Scienze Chirurgiche, Odontostomatologiche e Materno-Infantili Università di Verona, Italy
| | | | - Luca Richeldi
- UOC DI PNEUMOLOGIA, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
| | - Angela Santoni
- Dipartimento di Medicina Molecolare, Università; “Sapienza”, Roma, Italy
| | - Michele Schiappoli
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | | | - Alberto Villani
- Unità Operativa Complessa di Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico S.Martino, University of Genoa, Italy
| | - ARIA Italia
- Unit of Allergology, Clinical Immunology & Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
- Allergy and Respiratory Diseases, IRCCS Policlinico S.Martino, University of Genoa, Italy
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, MI, Italy
- Dipartimento Fisiopatologia Medico-chirurgica e Trapianti Università di Milano, IRCCS Fondazione Cà Granda, Policlinico di Milano, Italy
- Dipartimento di Scienze Cardiovascolari e Toraciche, Università Cattolica del Sacro Cuore, Roma, Italy
- Unità Operativa di Otorinolaringoiatria Ospedale Universitario I.R.C.C.S. San Raffaele, Milan, Italy
- Dipartimento DISC Clinica Otorinolaringoiatra IRCCS Policlinico San Martino, Università di Genova, Italy
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy
- DBSV, Clinica ORL, Università Insubria, ASST-settelaghi, HNS&FDR Center, Varese, Italy
- SOS Allergologia e Immunologia Clinica Prato, USL Toscana Centro, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Italy
- Clinica Otorinolaringoiatrica, Dipartimento di Medicina Clinica e Sperimentale, Università di Foggia, Italy
- Università degli Studi di Roma “Sapienza”, Direttore Scientifico di Area Pediatrica, Società Italiana di Pediatria, Italy
- Pediatric National Healthcare System, Turin, Institute of Biomedical Research and Innovation Palermo, Italy
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
- Clinica ORL, Asst Settelaghi Varese, Università degli Studi dell’ Insubria, Varese, Italy
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical & Research Center, Rozzano, MI, Italy
- UOC Pneumologia, Azienda Ospedaliera Universitaria, Verona, Italy
- Servizio di Allergologia, Casa della Salute di Scilla, ASP di Reggio Calabria, Italy
- Pediatrics, Dept. of Experimental Medicine, University of Pisa, Italy
- Dipartimento di Scienze Chirurgiche, Odontostomatologiche e Materno-Infantili Università di Verona, Italy
- Dipartimento Toracico Azienda USL ROMAGNA (I), Italy
- UOC DI PNEUMOLOGIA, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
- Dipartimento di Medicina Molecolare, Università; “Sapienza”, Roma, Italy
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
- ASST Rodhense Pneumologia, Italy
- Unità Operativa Complessa di Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Roma, Italy
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10
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Abstract
Based on a review of the most current medical literature, this article outlines the basic concepts and classifications of rhinosinusitis, and delineates best practices for clinical diagnoses and the most up-to-date management strategies. Learning to recognize and differentiate these conditions helps facilitate appropriate and timely diagnoses as well as helping practitioners provide their patients with better counseling and care.
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Affiliation(s)
- Benjamin S Bleier
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
| | - Marianella Paz-Lansberg
- Clinical Fellow of Rhinology & Skull Base Surgery, Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
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11
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C Morse J, Miller C, Senior B. Management of Chronic Rhinosinusitis with Nasal Polyposis in the Era of Biologics. J Asthma Allergy 2021; 14:873-882. [PMID: 34285514 PMCID: PMC8285230 DOI: 10.2147/jaa.s258438] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/30/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose of Review Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a phenotypic designation of the broader condition of chronic rhinosinusitis. The advent of targeted biologics has shown promise in targeting different aspects of the inflammatory pathway, yet there remains a lack of consensus on the correct timing and use of these medications. This review seeks to provide a concise update of the available literature on the pathophysiology of CRSwNP, the evolution and cost utility of biologics as it pertains to management of patients with CRSwNP, and evidence for each available biologic and its use in CRSwNP. Recent Findings There are two biologics with FDA approval for use in CRSwNP: dupilumab and omalizumab. Recent clinical trials of other biologic therapies targeting type 2 inflammatory pathways have also demonstrated efficacy both in symptom scores and nasal polyp reduction. However, studies have questioned the cost utility of these medications compared to other interventions. Furthermore, timing of use with respect to other interventions including surgery remains challenging.
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Affiliation(s)
- Justin C Morse
- University of North Carolina Department of Otolaryngology-Head and Neck Surgery, University of North Carolina Medical Center, Chapel Hill, NC, 27599, USA
| | - Craig Miller
- University of North Carolina Department of Otolaryngology-Head and Neck Surgery, University of North Carolina Medical Center, Chapel Hill, NC, 27599, USA
| | - Brent Senior
- University of North Carolina Department of Otolaryngology-Head and Neck Surgery, University of North Carolina Medical Center, Chapel Hill, NC, 27599, USA
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12
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Xu Y, Bi M, Tan KS, Mi J, Hong H. Biologics in Treatment for Chronic Rhinosinusitis with Comorbid Asthma. CURRENT TREATMENT OPTIONS IN ALLERGY 2021. [DOI: 10.1007/s40521-021-00282-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Anselmo-Lima WT, Tamashiro E, Romano FR, Miyake MM, Roithmann R, Kosugi EM, Nakanishi M, Fornazieri MA, Bezerra TFP, Mello JF, Lessa MM, Voegels RL, Piltcher OB, Sakano E, Valera FCP. Guideline for the use of immunobiologicals in chronic rhinosinusitis with nasal polyps (CRSwNP) in Brazil. Braz J Otorhinolaryngol 2021; 88:471-480. [PMID: 33867274 PMCID: PMC9422446 DOI: 10.1016/j.bjorl.2021.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/22/2022] Open
Abstract
The use of immunobiologicals is an option for the management of patients with chronic rinosinusitis with nasal polyps (CRSwNP) refractory to conventional treatment. The guideline lists the main drugs currently available in Brazil, their indications, and recommendations for use.
Introduction Severe uncontrolled chronic rhinosinusitis with nasal polyps has a negative impact on an individual’s quality of life. Therefore, new biologics have emerged for use in specific phenotypes of chronic rhinosinusitis, changing the paradigms of its treatment. Objective To review the current status of biologic treatment indications in chronic rhinosinusitis. Methods The Brazilian Academy of Rhinology brought together different specialists to suggest a course of action, considering its particularities and aspects related to the national reality. Results Of particular interest for decision making will be the identification of subgroups of patients refractory to pre-existing treatment options and the construction of a strategy that improves their quality of life, with the best cost-benefit ratio. Conclusion The use of biologics is a valid option for treatment in more severe cases. This strategy must be better understood and improved in the future, with more studies and greater clinical experience.
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Affiliation(s)
- Wilma T Anselmo-Lima
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil
| | - Edwin Tamashiro
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil
| | - Fabrizio R Romano
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina (FM), São Paulo, SP, Brazil
| | - Marcel M Miyake
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil; Hospital da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | | | - Eduardo M Kosugi
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), São Paulo, SP, Brazil
| | - Márcio Nakanishi
- Universidade de Brasília (UnB), Faculdade de Medicina, Brasilia, DF, Brazil
| | - Marco A Fornazieri
- Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil; Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brazil
| | | | - João F Mello
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), São Paulo, SP, Brazil
| | - Marcus M Lessa
- Universidade Federal da Bahia, Faculdade de Medicina, Salvador, BA, Brazil
| | - Richard L Voegels
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), São Paulo, SP, Brazil
| | - Otávio B Piltcher
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina (FAMED), Porto Alegre, RS, Brazil
| | - Eulalia Sakano
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Medicina, São Paulo, SP, Brazil
| | - Fabiana C P Valera
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil.
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14
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Lee HS, Gonzalez-Gil A, Drake V, Li TA, Schnaar RL, Kim J. Induction of the endogenous sialoglycan ligand for eosinophil death receptor Siglec-8 in chronic rhinosinusitis with hyperplastic nasal polyposis. Glycobiology 2021; 31:1026-1036. [PMID: 33755113 DOI: 10.1093/glycob/cwab018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 02/15/2021] [Accepted: 03/01/2021] [Indexed: 12/14/2022] Open
Abstract
Siglec-8, an immune-inhibitory sialoglycan binding lectin (S8), is expressed on the surface of eosinophils and mast cells, potent mediators of allergic inflammation. When S8 engages endogenous sialoglycan ligands, eosinophils undergo apoptosis and mast cell mediator release is inhibited. In the human airway, Siglec-8 ligands (S8L) are sialylated keratan sulfate chains carried on isoforms of the protein Deleted in Malignant Brain Tumors-1 (DMBT1), an immunoregulatory protein that we recently identified as the endogenous ligand for S8, DMBT1S8. We herein report that S8L is overexpressed in chronic rhinosinusitis with nasal polyposis (CRSwNP), a prevalent eosinophilic laden airway disease. Quantification and comparison of the degree to which DMBT1 carries the S8L by immunoblot analysis and lectin blot overlay, respectively, from nasal lavage showed that the S8L/DMBT1 ratio was significantly increased in CRSwNP vs control or CRS patients. We identified the histological sites of S8L and DMBT1 expression in fresh surgically resected human nasal polyps. Histochemistry of diseased polyps and adjacent non-diseased middle turbinate tissue from CRSwNP demonstrated colocalization of S8L and DMBT1 with highest staining in submucosal glands >> epithelium > stoma. S8L expression was specifically elevated in the submucosal glands and epithelium of polyp tissue compared to middle turbinate. We hypothesize that expression of the isoform of DMBT1 carrying the Siglec-8 binding sialoglycan, DMBT1S8, is induced in polyps of CRSwNP specifically at the site of disease, is produced in the submucosal glands of polyps and secreted into the lumen of the sinonasal cavity as a host response to mitigate eosinophil-mediated inflammation.
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Affiliation(s)
- Hyun Sil Lee
- Department of Medicine, Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, USA.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, USA
| | - Anabel Gonzalez-Gil
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Virginia Drake
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, USA
| | - T August Li
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Ronald L Schnaar
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Jean Kim
- Department of Medicine, Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, USA.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, USA
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15
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Chong LY, Piromchai P, Sharp S, Snidvongs K, Webster KE, Philpott C, Hopkins C, Burton MJ. Biologics for chronic rhinosinusitis. Cochrane Database Syst Rev 2021; 3:CD013513. [PMID: 33710614 PMCID: PMC8094915 DOI: 10.1002/14651858.cd013513.pub3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND This living systematic review is one of several Cochrane Reviews evaluating the medical management of patients with chronic rhinosinusitis. Chronic rhinosinusitis is common. It is characterised by inflammation of the nasal and sinus linings, nasal blockage, rhinorrhoea, facial pressure/pain and loss of sense of smell. It occurs with or without nasal polyps. 'Biologics' are medicinal products produced by a biological process. Monoclonal antibodies are one type, already evaluated in other inflammatory conditions (e.g. asthma and atopic dermatitis). OBJECTIVES To assess the effects of biologics for the treatment of chronic rhinosinusitis. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Register; CENTRAL (2020, Issue 9); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished studies. The date of the search was 28 September 2020. SELECTION CRITERIA Randomised controlled trials (RCTs) with at least three months follow-up comparing biologics (monoclonal antibodies) against placebo/no treatment in patients with chronic rhinosinusitis. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Our primary outcomes were disease-specific health-related quality of life (HRQL), disease severity and serious adverse events (SAEs). The secondary outcomes were avoidance of surgery, extent of disease (measured by endoscopic or computerised tomography (CT) score), generic HRQL and adverse effects (nasopharyngitis, including sore throat). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included 10 studies. Of 1262 adult participants, 1260 had severe chronic rhinosinusitis with nasal polyps; 43% to 100% of participants also had asthma. Three biologics, with different targets, were evaluated: dupilumab, mepolizumab and omalizumab. All of the studies were sponsored or supported by industry. For this update (2021) we have included two new studies, including 265 participants, which reported data relating to omalizumab. Anti-IL-4Rα mAb (dupilumab) versus placebo/no treatment (all receiving intranasal steroids) Three studies (784 participants) evaluated dupilumab. Disease-specific HRQL was measured with the SNOT-22 (a 22-item questionnaire, with a score range of 0 to 110; minimal clinically important difference (MCID) 8.9 points). At 24 weeks, dupilumab results in a large reduction (improvement) in the SNOT-22 score (mean difference (MD) -19.61, 95% confidence interval (CI) -22.54 to -16.69; 3 studies; 784 participants; high certainty). At between 16 and 52 weeks of follow-up, dupilumab probably results in a large reduction in disease severity, as measured by a 0- to 10-point visual analogue scale (VAS) (MD -3.00, 95% CI -3.47 to -2.53; 3 studies; 784 participants; moderate certainty). This is a global symptom score, including all aspects of chronic rhinosinusitis symptoms. At between 16 and 52 weeks of follow-up, dupilumab may result in a reduction in serious adverse events compared to placebo (5.9% versus 12.5%, risk ratio (RR) 0.47, 95% CI 0.29 to 0.76; 3 studies, 782 participants; low certainty). Anti-IL-5 mAb (mepolizumab) versus placebo/no treatment (all receiving intranasal steroids) Two studies (137 participants) evaluated mepolizumab. Disease-specific HRQL was measured with the SNOT-22. At 25 weeks, the SNOT-22 score may be reduced (improved) in participants receiving mepolizumab (MD -13.26 points, 95% CI -22.08 to -4.44; 1 study; 105 participants; low certainty; MCID 8.9). It is very uncertain whether there is a difference in disease severity at 25 weeks: on a 0- to 10-point VAS, disease severity was -2.03 lower in those receiving mepolizumab (95% CI -3.65 to -0.41; 1 study; 72 participants; very low certainty). It is very uncertain if there is a difference in the number of serious adverse events at between 25 and 40 weeks (1.4% versus 0%; RR 1.57, 95% CI 0.07 to 35.46; 2 studies; 135 participants, very low certainty). Anti-IgE mAb (omalizumab) versus placebo/no treatment (all receiving intranasal steroids) Five studies (329 participants) evaluated omalizumab. Disease-specific HRQL was measured with the SNOT-22. At 24 weeks omalizumab probably results in a large reduction in SNOT-22 score (MD -15.62, 95% CI -19.79 to -11.45; 2 studies; 265 participants; moderate certainty; MCID 8.9). We did not identify any evidence for overall disease severity. It is very uncertain whether omalizumab affects the number of serious adverse events, with follow-up between 20 and 26 weeks (0.8% versus 2.5%, RR 0.32, 95% CI 0.05 to 2.00; 5 studies; 329 participants; very low certainty). AUTHORS' CONCLUSIONS Almost all of the participants in the included studies had nasal polyps (99.8%) and all were using topical nasal steroids for their chronic rhinosinusitis symptoms. In these patients, dupilumab improves disease-specific HRQL compared to placebo. It probably also results in a reduction in disease severity, and may result in a reduction in the number of serious adverse events. Mepolizumab may improve disease-specific HRQL. It is very uncertain if there is a difference in disease severity or the number of serious adverse events. Omalizumab probably improves disease-specific HRQL compared to placebo. It is very uncertain if there is a difference in the number of serious adverse events. There was no evidence regarding the effect of omalizumab on disease severity (using global scores that address all symptoms of chronic rhinosinusitis).
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Affiliation(s)
- Lee-Yee Chong
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Patorn Piromchai
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Steve Sharp
- National Institute for Health and Care Excellence, Manchester, UK
| | - Kornkiat Snidvongs
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Carl Philpott
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
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16
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Tiotiu A, Novakova P, Baiardini I, Bikov A, Chong-Neto H, de-Sousa JC, Emelyanov A, Heffler E, Fogelbach GG, Kowal K, Labor M, Mihaicuta S, Nedeva D, Novakova S, Steiropoulos P, Ansotegui IJ, Bernstein JA, Boulet LP, Canonica GW, Dubuske L, Nunes C, Ivancevich JC, Santus P, Rosario N, Perazzo T, Braido F. Manifesto on united airways diseases (UAD): an Interasma (global asthma association - GAA) document. J Asthma 2021; 59:639-654. [PMID: 33492196 DOI: 10.1080/02770903.2021.1879130] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The large amount of evidence and the renewed interest in upper and lower airways involvement in infectious and inflammatory diseases has led Interasma (Global Asthma Association) to take a position on United Airways Diseases (UAD). METHODS Starting from an extensive literature review, Interasma executive committee discussed and approved this Manifesto developed by Interasma scientific network (INES) members. RESULTS The manifesto describes the evidence gathered to date and defines, states, advocates, and proposes issues on UAD (rhinitis, rhinosinusitis and nasal polyposis), and concomitant/comorbid lower airways disorders (asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, obstructive sleep apnoea) with the aim of challenging assumptions, fostering commitment, and bringing about change. UAD refers to clinical pictures characterized by the coexistence of upper and lower airways involvement, driven by a common pathophysiological mechanism, leading to a greater burden on patient's health status and requiring an integrated diagnostic and therapeutic plan. The high prevalence of UAD must be taken into account. Upper and lower airways diseases influence disease control and patient's quality of life. CONCLUSIONS Patients with UAD need to have a timely and adequate diagnosis, treatment, and, when recommended, referral for management in a specialized center. Diagnostic testing including skin prick or serum specific IgE, lung function, fractional exhaled nitric oxide (FeNO), polysomnography, allergen-specific immunotherapies, biological therapies and home based continuous positive airway pressure (CPAP) whenever these are recommended, should be part of the management plan for UAD. Education of medical students, physicians, health professionals, patients and caregivers on the UAD is needed.
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Affiliation(s)
- Angelica Tiotiu
- Department of Pulmonology, University Hospital of Nancy, Nancy, France.,EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, University of Lorraine, Nancy, France
| | - Plamena Novakova
- Clinic of Clinical Allergy, Medical University Sofia, Sofia, Bulgaria
| | - Ilaria Baiardini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Andras Bikov
- Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - Herberto Chong-Neto
- Division of Allergy and Immunology, Department of Pediatrics, Federal University of Paraná, Curitiba, Brazil
| | - Jaime Correia- de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Alexander Emelyanov
- Department of Respiratory Medicine, North-Western Medical University named after I.I.Mechnikov, St-Petersburg, Russia
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
| | - Guillermo Guidos Fogelbach
- Clinic of Clinical Allergy, Medical University Sofia, Sofia, Bulgaria.,Instituto Politécnico Nacional, Escuela Nacional de Medicina y Homeopatía, Laboratorio de Bioquímica Estructural, Ciudad de México, México
| | - Krzysztof Kowal
- Department of Allergology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | | | - Stefan Mihaicuta
- Pulmonology Department, Cardio Prevent Foundation, University of Medicine and Pharmacy "Dr Victor Babes", Timisoara, Romania
| | - Denislava Nedeva
- Clinic of Clinical Allergy, Medical University Sofia, Sofia, Bulgaria
| | - Sylvia Novakova
- Allergy Unit of Internal Consulting Department, University Hospital "St. George", Plovdiv, Bulgaria
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Immunology, Allergy Section University of Cincinnati, Cincinnati, OH, USA
| | | | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
| | - Lawrence Dubuske
- Division of Allergy and Immunology, Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Carlos Nunes
- Centro de ImmunoAlergologia de Algarve, Porto, Portugal
| | - Juan Carlos Ivancevich
- Immunology Department, Faculty of Medicine, del Salvador University, Buenos Aires, Argentina
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences, University of Milan, Division of Respiratory Diseases "L. Sacco" Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Tommaso Perazzo
- Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Fulvio Braido
- Department of Internal Medicine, University of Genoa, Genova, Italy.,Respiratory Unit for Continuity of Care IRCCS, Ospedale Policlinico San Martino, Genova, Italy
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17
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Yoshida K, Takabayashi T, Kaneko A, Takiyama M, Sakashita M, Imoto Y, Kato Y, Narita N, Fujieda S. Baicalin suppresses type 2 immunity through breaking off the interplay between mast cell and airway epithelial cell. JOURNAL OF ETHNOPHARMACOLOGY 2021; 267:113492. [PMID: 33091489 DOI: 10.1016/j.jep.2020.113492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The traditional Japanese herbal medicine Shin'iseihaito was reported to ameliorate the airway type 2 inflammatory response in clinical and experimental studies. Airway type 2 inflammatory diseases, including bronchial asthma and eosinophilic chronic rhinosinusitis (ECRS), often coexist and interact with each other. However, it is still unclear how Shin'iseihaito exerts its pharmacological effects on cells involved in airway mucosa. AIM OF THE STUDY This study aims to examine the direct effect of baicalin, a representative bioactive compound of Shin'iseihaito, on type 2 immune responses in human airway epithelial cells and mast cells. MATERIAL AND METHODS We measured the plasma pharmacokinetics of flavonoids derived from Shin'iseihaito and investigated the effects of baicalin on type 2 immune responses in human airway epithelial cells and human mast cells. RESULTS Baicalin, wogonin, and wogonoside were detected in the plasma. The maximum plasma concentration of baicalin was highest at 1610 ng/ml (3.6 μM). In the normal human bronchial epithelial cells treated with baicalin, with or without stimulation by IFN-γ, the IL-33 expression was significantly downregulated. However, baicalin treatment did not affect the levels of thymic stromal lymphopoietin and IL-25. We noted that IL-33-dependent expression of tryptase mRNA in mast cells was significantly inhibited by baicalin. Also, the expression of IL-5 in mast cells enhanced by stimulation with TSLP plus IL-1β was significantly downregulated by baicalin treatment. Moreover, the enhancement of IL-13 expression in mast cells by IL-33 simulation was also significantly inhibited by baicalin. CONCLUSIONS Our results prove that by breaking off the vicious circle of mast cells and airway epithelial cells, baicalin may be an effective alternative therapeutic option for the treatment of type 2 inflammatory diseases, such as ECRS and comorbid asthma.
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Affiliation(s)
- Kanako Yoshida
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Sensory and Locomotor Medicine, University of Fukui, 23 Shimoaizuki, Matsuoka, Yoshida, Fukui, Japan
| | - Tetsuji Takabayashi
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Sensory and Locomotor Medicine, University of Fukui, 23 Shimoaizuki, Matsuoka, Yoshida, Fukui, Japan.
| | - Atsushi Kaneko
- Tsumura Kampo Research Laboratories, Tsumura & Co., 3586 Yoshiwara, Ami- Machi, Inashiki-gun, Ibaraki, Japan
| | - Mikina Takiyama
- Tsumura Kampo Research Laboratories, Tsumura & Co., 3586 Yoshiwara, Ami- Machi, Inashiki-gun, Ibaraki, Japan
| | - Masafumi Sakashita
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Sensory and Locomotor Medicine, University of Fukui, 23 Shimoaizuki, Matsuoka, Yoshida, Fukui, Japan
| | - Yoshimasa Imoto
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Sensory and Locomotor Medicine, University of Fukui, 23 Shimoaizuki, Matsuoka, Yoshida, Fukui, Japan
| | - Yukinori Kato
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Sensory and Locomotor Medicine, University of Fukui, 23 Shimoaizuki, Matsuoka, Yoshida, Fukui, Japan
| | - Norihiko Narita
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Sensory and Locomotor Medicine, University of Fukui, 23 Shimoaizuki, Matsuoka, Yoshida, Fukui, Japan
| | - Shigeharu Fujieda
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Sensory and Locomotor Medicine, University of Fukui, 23 Shimoaizuki, Matsuoka, Yoshida, Fukui, Japan
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18
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Breslin NK, Heindel NH, Haberman RS. Role of Interleukin 5 Inhibition in the Treatment of Eosinophilic Otitis Media. OTO Open 2021; 5:2473974X21991449. [PMID: 33598601 PMCID: PMC7863164 DOI: 10.1177/2473974x21991449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Eosinophilic otitis media (EOM) is a rare form of middle ear disease characterized by a viscous effusion rich in eosinophils, a resistance to conventional treatments, and an association with bronchial asthma. The relationship between asthma and EOM suggests similarities in pathogenesis and treatment possibilities. Recent biologic therapies, specifically those that target interleukin 5 (IL-5), have demonstrated efficacy in controlling eosinophil-driven asthma, yet their impact on the treatment of pathologically similar diseases remains unmeasured. This study identifies patients who have EOM, reviews their otologic clinical course, and investigates the impact of anti-IL-5 drugs on chronic ear disease. Study Design Retrospective chart review. Setting University of Florida Health, an academic medical center. Methods A review of 120 patients treated with benralizumab or mepolizumab was performed. Imaging evidence of otomastoiditis was used to identify 9 patients with possible EOM. Two patients were treated with benralizumab, and the remaining 7 received mepolizumab injections. Results After starting treatment, 5 patients had complete resolution of middle ear effusions (3 with mepolizumab and 2 with benralizumab); 1 had stable middle ear effusion; and 1 patient’s disease status could not be determined due to a lack of follow-up. The remaining 2 patients did not have effusions at the time when anti-IL-5 therapy was initiated, and they have not relapsed since starting treatment. Conclusion EOM is a rare disease that otolaryngologists should include in their differential diagnosis, especially in refractory cases. Anti-IL-5 agents show efficacy in treating EOM, and prospective multicenter clinical trials are needed to further characterize the effect of anti-IL-5 therapies.
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Affiliation(s)
| | - N Hadley Heindel
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Rex S Haberman
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
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19
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Bartier S, Coste A, Bequignon E. [Management strategies for chronic rhinosinusitis with nasal polyps in adults]. Rev Mal Respir 2021; 38:183-198. [PMID: 33541753 DOI: 10.1016/j.rmr.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Chronic rhinosinusitis with nasal polyps (CRSwNP) is one of the categories of chronic rhinosinusitis and is defined by the presence of bilateral polyps. It is frequently associated with other conditions (asthma, atopy, aspirin intolerance), which worsen its prognosis. STATE OF ART The pathophysiology of CRSwNP is still poorly understood. The genesis of polyps is thought to be based on an initial epithelial lesion caused by environmental factors in the context of self-maintained chronic local inflammation. Multiple local and general factors can be involved in this inflammation, which is mainly of Th2 type in Europe. Abnormalities of the epithelial barrier and the immune system (eosinophilia, cytokines, T and B lymphocytes), genetic factors and pathogens, including Staphylococcus aureus, have been incriminated. The treatment of CRSwNP is mainly based on the application of local corticosteroids. Surgery remains an important part of patient management where CRSwNP becomes resistant to topical therapy. The management of CRSwNP may be at a turning point thanks to the arrival of biological therapies (anti-IgE, anti-IL-5, anti-IL-4/IL-13) the initial results of which are promising. PERSPECTIVES/CONCLUSIONS With the new concept of endotypes, current avenues of research are moving towards a better understanding of the inflammatory mechanisms of CRSwNP. Immunotherapy appears to be a promising future for the treatment of CRSwNP.
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Affiliation(s)
- S Bartier
- Service d'ORL et chirurgie cervico-faciale, centre hospitalier intercommunal de Créteil, Créteil, France; Service d'ORL et chirurgie cervico-faciale, CHU Henri-Mondor, 51, avenue du Maréchal-De-Lattre-de-Tassigny, 94000 Créteil, France.
| | - A Coste
- Service d'ORL et chirurgie cervico-faciale, centre hospitalier intercommunal de Créteil, Créteil, France; Service d'ORL et chirurgie cervico-faciale, CHU Henri-Mondor, 51, avenue du Maréchal-De-Lattre-de-Tassigny, 94000 Créteil, France
| | - E Bequignon
- Service d'ORL et chirurgie cervico-faciale, centre hospitalier intercommunal de Créteil, Créteil, France; Service d'ORL et chirurgie cervico-faciale, CHU Henri-Mondor, 51, avenue du Maréchal-De-Lattre-de-Tassigny, 94000 Créteil, France
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20
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Lin J, Huang N, Li J, Liu X, Xiong Q, Hu C, Chen D, Guan L, Chang K, Li D, Tsui SKW, Zhong N, Liu Z, Yang PC. Cross-reactive antibodies against dust mite-derived enolase induce neutrophilic airway inflammation. Eur Respir J 2021; 57:13993003.02375-2019. [PMID: 32817257 DOI: 10.1183/13993003.02375-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Neutrophilic inflammation is a hallmark of some specific asthma phenotypes; its aetiology is not yet fully understood. House dust mite (HDM) is the most common factor in the pathogenesis of airway inflammation. This study aims to elucidate the role of cross-antibodies against HDM-derived factors in the development of neutrophilic inflammation in the airway. METHODS Blood samples were collected from asthma patients with chronic neutrophilic asthma for analysis of HDM-specific cross-reactive antibodies. The role of an antibody against HDM-derived enolase (EnoAb) in the impairment of airway epithelial barrier function and induction of airway inflammation was assessed in a cell culture model and an animal model. RESULTS High similarity (72%) of the enolase gene sequences was identified between HDM and human. Serum EnoAb was detected in patients with chronic neutrophilic asthma. The EnoAb bound to airway epithelial cells to form complexes with enolase, which activated complement, impaired airway epithelial barrier functions and induced neutrophilic inflammation in the airway tissues. CONCLUSIONS HDM-derived enolase can induce specific cross-antibodies in humans, which induce neutrophilic inflammation in the airway.
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Affiliation(s)
- Jianli Lin
- State Key Laboratory of Respiratory Disease for Allergy at Shenzhen University, Shenzhen University School of Medicine, Shenzhen, China.,State Key Laboratory of Respiratory Disease, National Clinical Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.,These authors contributed equally to this work
| | - Nana Huang
- State Key Laboratory of Respiratory Disease for Allergy at Shenzhen University, Shenzhen University School of Medicine, Shenzhen, China.,These authors contributed equally to this work
| | - Jing Li
- State Key Laboratory of Respiratory Disease, National Clinical Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.,These authors contributed equally to this work
| | - Xiaoyu Liu
- State Key Laboratory of Respiratory Disease for Allergy at Shenzhen University, Shenzhen University School of Medicine, Shenzhen, China.,These authors contributed equally to this work
| | - Qing Xiong
- School of Biomedical Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Chengshen Hu
- State Key Laboratory of Respiratory Disease for Allergy at Shenzhen University, Shenzhen University School of Medicine, Shenzhen, China
| | - Desheng Chen
- State Key Laboratory of Respiratory Disease for Allergy at Shenzhen University, Shenzhen University School of Medicine, Shenzhen, China
| | - Lvxin Guan
- State Key Laboratory of Respiratory Disease for Allergy at Shenzhen University, Shenzhen University School of Medicine, Shenzhen, China
| | - Kexin Chang
- State Key Laboratory of Respiratory Disease for Allergy at Shenzhen University, Shenzhen University School of Medicine, Shenzhen, China
| | - Dan Li
- State Key Laboratory of Respiratory Disease for Allergy at Shenzhen University, Shenzhen University School of Medicine, Shenzhen, China
| | | | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.,Nanshan Zhong, Zhigang Liu and Ping-Chang Yang contributed equally to this article as lead authors and supervised the work
| | - Zhigang Liu
- State Key Laboratory of Respiratory Disease for Allergy at Shenzhen University, Shenzhen University School of Medicine, Shenzhen, China.,Nanshan Zhong, Zhigang Liu and Ping-Chang Yang contributed equally to this article as lead authors and supervised the work
| | - Ping-Chang Yang
- State Key Laboratory of Respiratory Disease for Allergy at Shenzhen University, Shenzhen University School of Medicine, Shenzhen, China.,Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Shenzhen, China.,Nanshan Zhong, Zhigang Liu and Ping-Chang Yang contributed equally to this article as lead authors and supervised the work
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21
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Bochner BS, Stevens WW. Biology and Function of Eosinophils in Chronic Rhinosinusitis With or Without Nasal Polyps. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:8-22. [PMID: 33191674 PMCID: PMC7680832 DOI: 10.4168/aair.2021.13.1.8] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/23/2020] [Indexed: 12/24/2022]
Abstract
Chronic rhinosinusitis (CRS) with or without nasal polyposis is a complex medical condition characterized by varying patterns of chronic innate and adaptive mucosal inflammation. Treatment of CRS has been traditionally limited to corticosteroids and sinus surgery; however, novel biologics have more recently been evaluated as steroid- and surgery-sparing options. While it is clear that there are different subtypes or endotypes of CRS, perhaps the most frequent presentation involves the features of type 2 inflammation, including a prominent tissue eosinophilia component. The purpose of this review is to provide an update on eosinophil biology as well as on the potential contribution of eosinophils and their mediators to the pathophysiology of CRS, drawing mechanistic conclusions mainly from studies of human sinus mucosal tissues, nasal secretions, and benefits (or lack thereof) from the use of various pharmacotherapies. The unavoidable conclusion derived from this approach is that eosinophils themselves cannot fully explain the underlying pathophysiology of this complex disorder.
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Affiliation(s)
- Bruce S Bochner
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Whitney W Stevens
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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22
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Armengot-Carceller M, Gómez-Gómez MJ, García-Navalón C, Doménech-Campos E, Muñoz-Fernández N, Miguel AGLD, Marco-Algarra J, Palop-Cervera M, Piñero AG. Effects of Omalizumab Treatment in Patients With Recalcitrant Nasal Polyposis and Mild Asthma: A Multicenter Retrospective Study. Am J Rhinol Allergy 2020; 35:516-524. [PMID: 33153272 DOI: 10.1177/1945892420972326] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a clinical entity with specific features that impacts significantly on patient quality of life (QoL). CRSwNP is often associated with asthma and is difficult to control and manage despite pharmacological and/or surgical treatment. Omalizumab, a monoclonal anti-IgE antibody, has emerged as a putative therapeutic option. OBJECTIVE To evaluate the effects of omalizumab on nasal polyp (NP) size and QoL assessed by Sino-Nasal Outcome Test-22 (SNOT-22) in patients with recalcitrant CRSwNP and mild asthma. METHODS A multicenter retrospective analysis of patient data from the Community of Valencia (Spain) was performed. Adult patients with recalcitrant CRSwNP and comorbid mild asthma receiving compassionate use of omalizumab were included. NP size measured by total nasal endoscopic polyp score (TPS) and QoL evaluated through the SNOT-22 questionnaire were assessed at baseline and monthly over 12 months. An ordinal regression model was built to analyze the results. RESULTS A total of 23 CRSwNP patients with a mean age (± SD) of 54.78 ± 9.46 years were included. Nineteen suffered from aspirin-exacerbated respiratory disease (AERD). In all patients, a significant and sustained reduction in TPS was observed over time, accompanied by improvements in QoL reflected in lower SNOT-22 scores. In the ordinal regression model, time but not total IgE, age or tissue eosinophilia impacted on NP size and SNOT-22 outcomes. Additionally, improvements in QoL were not explained by reductions in the size of polyps. CONCLUSION Omalizumab was effective for the treatment of patients with recalcitrant CRSwNP and mild asthma, even when AERD was present, by reducing NP size and improving QoL; treatment time was a key factor. SNOT-22 improvements were not explained by decreases in TPS, indicating that omalizumab may be effective in all patients, regardless of polyp size.
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Affiliation(s)
- Miguel Armengot-Carceller
- Otolaryngology Department, University and Polytechnic La Fe Hospital, Valencia, Spain.,Department of Surgery, Valencia University, Valencia, Spain.,Grupo de Biomedicina Molecular, Celular y Genómica (BMCG), Health Research Institute La Fe, Valencia, Spain.,CIBER of Respiratory Diseases, Instituto de Salut Carlos III, Ministerio de Ciencia e Innovación, Madrid, Spain
| | | | - Carmen García-Navalón
- Department of Surgery, Valencia University, Valencia, Spain.,Otolaryngology Department, University General Hospital of Valencia, University of Valencia, Valencia, Spain
| | | | | | | | - Jaime Marco-Algarra
- Department of Surgery, Valencia University, Valencia, Spain.,Otolaryngology Department, University Clinic Hospital of Valencia, Valencia, Spain
| | | | - Alfonso García Piñero
- Otolaryngology Department, University and Polytechnic La Fe Hospital, Valencia, Spain
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23
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Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis (CRS) is a broad classification of airway inflammation that affects a significant portion of the population. The current model of delineating patients suffering from CRS is dated and is no longer as simple as the presence of polyps or no polyps. Continued advances in the endotype descriptions of CRS have allowed for new phenotypic descriptions that aid in driving management and research efforts. RECENT FINDINGS Geographic differences exist between patient presentations, which require a molecular evaluation of the driving forces. Increased understanding of these differences allows for patient-specific treatment decisions. SUMMARY New descriptions of CRS phenotypes allow for more targeted therapy for patients, particularly to those with difficult to control disease. The previously broad classification of CRS with or without nasal polyps is no longer sufficient at driving these treatment decisions.
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24
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Manciula LG, Jeican II, Tudoran LB, Albu S. Biofilms and inflammation in patients with chronic rhinosinusitis. Med Pharm Rep 2020; 93:374-383. [PMID: 33225263 PMCID: PMC7664719 DOI: 10.15386/mpr-1691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/15/2020] [Accepted: 07/03/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction The aim of the present study is to evaluate the presence of biofilms in patients with chronic rhinosinusitis (CRS), with or without nasal polyps, and their relationship to eosinophils and plasma cells. We compared the results with those obtained in nonCRS patients. Methods A total of 50 patients were included in the study, 30 CRSwNP patients, 10 CRSsNP cases and 10 control patients who were operated for deviated septum. Biofilm detection was performed by means of H&E staining and SEM. Eosinophil and plasma cell values were recorded and compared between groups. Results Biofilms were identified in 30 patients (60%), 76.6% (23 out of 30) of the CRSwNP patients, 70% (7 out of 10) of the CRSsNP patients and none of the septoplasty patients. Eosinophil and plasma cell values were more elevated in CRS patients, being strongly correlated to biofilm presence and nasal polyposis. Conclusion Biofilm presence was demonstrated in many of the CRS patients, with no evidence in the control cases. Our study findings indicate that inflammatory cell counts are higher in patients with CRS compared to controls, but also more elevated in patients with polyposis. In biofilm-positive patients, eosinophil and plasma cell counts were greater than those in patients without biofilms, demonstrating the proinflammatory action of the biofilm in the sino-nasal pathology.
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Affiliation(s)
- Lavinia-Gianina Manciula
- 2 Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ionut Isaia Jeican
- Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. Department of Anatomy and Embryology, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca
| | - Lucian Barbu Tudoran
- "Prof. C. Craciun" Electron Microscopy Laboratory, Faculty of Biology & Geology, Babes-Bolyai University; Electron Microscopy Integrated Laboratory, National Institute for R&D of Isotopic and Molecular Technologies, Cluj-Napoca, Romania
| | - Silviu Albu
- 2 Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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25
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Kim C, Han J, Wu T, Bachert C, Fokkens W, Hellings P, Hopkins C, Lee S, Mullol J, Lee JT. Role of Biologics in Chronic Rhinosinusitis With Nasal Polyposis: State of the Art Review. Otolaryngol Head Neck Surg 2020; 164:57-66. [PMID: 32746710 DOI: 10.1177/0194599820939964] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To review the current literature regarding the role of biologics in the treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP). DATA SOURCES PubMed/MEDLINE, EMBASE, Cochrane Review, ClinicalTrials.gov. REVIEW METHODS We conducted a comprehensive review of the literature on clinical studies investigating the efficacy of emerging biologics in CRSwNP, with a focus on randomized controlled trials. CONCLUSIONS There appears to be promising evidence to support the safety and efficacy of biologics in CRSwNP with and without asthma for select patients. However, additional large-scale randomized studies with longer follow-up are necessary to determine which patients would benefit the most from these novel systemic treatments. IMPLICATIONS FOR PRACTICE Chronic rhinosinusitis with nasal polyposis refractory to medical and surgical therapy remains a challenging clinical problem for otolaryngologists. However, emerging biologic therapies may offer a new therapeutic option for such patients with recalcitrant disease.
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Affiliation(s)
- Christine Kim
- Department of Head & Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Joseph Han
- Department of Otolaryngology, Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Tara Wu
- Department of Head & Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Claus Bachert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, University of Ghent, Ghent, Belgium
| | - Wytske Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - Peter Hellings
- Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, University of Ghent, Ghent, Belgium.,Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Stella Lee
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Joaquim Mullol
- Department of Otorhinolaryngology, Hospital Clínic Universitari, Barcelona, Spain
| | - Jivianne T Lee
- Department of Head & Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
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26
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Abstract
PURPOSE OF REVIEW To analyze the status of precision medicine in atopic diseases. RECENT FINDINGS Atopic diseases are increasingly recognized as heterogeneous in nature and they can be quite different in severity, response to therapy, triggers, genetic back ground, ancestral risk and type of inflammation. This significant variability in the landscape of atopic diseases is not reflected in the common treatment guidelines that follow 'one fits all' approach for their management. Such an approach is largely based on minimal 'phenotype' elements, such as severity of disease and response to therapy and does not reflect the information accumulate in the last 20 years about particular pathogenic pathways (endotypes) leading to disease (phenotypes) based on biomolecular analysis of the single individuals. Accumulating data have defined asthma allergic rhinitis, food allergy based on their endotypes and clinically relevant phenotypes. In general, atopic diseases can be largely classified as high or low Th2 inflammatory status, which may explain the severity and response to therapy. SUMMARY Precision medicine is aiming to use known endotype phenotype to guide specific individualized treatment. The work aimed in deep characterization of diseases to guide the disease management is crucial in light of the availability of ever more precise treatment able to target specific pathways.
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27
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Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory condition with different endotypes between patients from eastern or western countries. Targeted biologics are currently used to treat CRSwNP, but the outcomes widely vary. This review focuses on the present use of biologics for treating CRSwNP. RECENT FINDINGS Monoclonal biologics have been used as an innovative therapy for multiple allergic diseases and comorbid allergic conditions. Over the past several decades, numerous biomarkers have been investigated and were found to be closely correlated with CRSwNP, improving the understanding of inflammatory patterns and endotype classifications for CRSwNP and prompting discussion regarding the use of biologics in CRSwNP. Efficacies vary in reports of different research groups, but it has been found that patients with TH-2-driven inflammatory patterns respond better to the use of biologics than those with non-TH-2-driven CRSwNP. These findings suggest the importance and urgency of developing criteria for biologics in CRSwNP. SUMMARY Precisely determining patient criteria, identifying treatment biomarkers based on endotyping for CRSwNP and determinations of contraindications for long-term utilization may be useful for optimizing treatment strategies and improving the therapeutic efficacy of biologics to achieve long-term control starting at early stages.
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Heffler E, Saccheri F, Bartezaghi M, Canonica GW. Effectiveness of omalizumab in patients with severe allergic asthma with and without chronic rhinosinusitis with nasal polyps: a PROXIMA study post hoc analysis. Clin Transl Allergy 2020; 10:25. [PMID: 32607141 PMCID: PMC7318524 DOI: 10.1186/s13601-020-00330-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/11/2020] [Indexed: 12/17/2022] Open
Abstract
Background A significant proportion of patients with severe asthma may also suffer from nasal polyposis, which is commonly defined as chronic rhinosinusitis with nasal polyps (CRSwNP), the presence of which may adversely affect asthma treatment outcomes. The biologic agent omalizumab is effective as add-on therapy in patients with severe allergic asthma. The aim of this post hoc analysis of the PROXIMA study was to compare the efficacy of omalizumab between patients with severe allergic asthma, with and without comorbid CRSwNP. Methods PROXIMA was a prospective observational 2-part study conducted in Italy in adult patients with severe allergic asthma, where, in the second part, patients eligible for add-on omalizumab initiated treatment for 12 months. Patient baseline data such as comorbidities and history of exacerbations were collected. Outcomes were asthma control (Asthma Control Questionnaire [ACQ]), lung function (forced expiratory volume in 1 s [FEV1]) and exacerbation rate. The post hoc analysis compared these outcomes between the cohort with comorbid CRSwNP and the cohort without CRSwNP. Results Of 123 patients included in this analysis, 17 (13.8%) were in the CRSwNP cohort. There was no significant difference between cohorts in baseline clinical characteristics or in change from baseline at 12 months in ACQ values, % of predicted FEV1 or annual asthma exacerbation rate, although results were numerically in favor of the CRSwNP cohort versus the non-CRSwNP cohort. The proportion of patients who achieved an improvement in all three outcomes was numerically greater in the CRSwNP cohort (35.7% vs 23.0%). Conclusions In an observational real-world setting, add-on omalizumab for severe allergic asthma was effective in improving asthma control, lung function and in reducing exacerbations, including in those patients with CRSwNP.
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Affiliation(s)
- Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Mi Italy
| | - Fabiana Saccheri
- Medical & Scientific Department, Novartis Farma SpA, Origgio, Italy
| | - Marta Bartezaghi
- Medical & Scientific Department, Novartis Farma SpA, Origgio, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Mi Italy
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Kotisalmi E, Hakulinen A, Mäkelä M, Toppila-Salmi S, Kauppi P. A comparison of biologicals in the treatment of adults with severe asthma - real-life experiences. Asthma Res Pract 2020; 6:2. [PMID: 32467765 PMCID: PMC7222440 DOI: 10.1186/s40733-020-00055-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/17/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Anti-IgE (omalizumab) and anti-IL5/IL5R (reslizumab, mepolizumab and benralizumab) treatments are available for severe allergic and eosinophilic asthma. In these patients, studies have shown beneficial effects in oral corticosteroid use and exacerbations. The aim of this retrospective single-center study was to evaluate the effect of biological therapy on severe asthma and to compare different therapies. METHODS We collected and analysed results of anti-IL5/IL5R and anti-IgE therapies for asthma from January 2009 until October 2019 in specialized care. We compared number of exacerbations, asthma symptoms and use of per oral corticosteroids and antimicrobics because of asthma before and during biological therapy, and in a separate analysis need for per oral corticosteroids, antimicrobics or surgery due to upper respiratory tract diseases in asthmatics receiving biologicals. The analyses were done using the Chi square test, T-test or Mann-Whitney U -test, the Kruskall-Wallis test or the Wilcoxon test. RESULTS Of 64 patients, 40 used continuous per oral corticosteroid therapy prior to biological therapy. The mean daily dose of per oral corticosteroid was reduced in those with anti-IL5/IL5R therapy (- 3.0 mg, p = 0.02). The number of annual per oral corticosteroid courses decreased in both the anti-IL5/IL5R (- 2.8 courses, p < 0.05) and anti-IgE groups (- 1.3 courses, p < 0.05). The number of annual antibiotic courses (- 0.7 courses, p = 0.04) and total number of exacerbation events (- 4.4 events/year, p < 0.05) were reduced in the anti-IL5/IL5R group. In the 55 asthma patients analysed for upper respiratory tract findings, the results suggested a reduction in need for chronic rhinosinusitis surgery during biological therapy. CONCLUSIONS Results with biological therapies in this real-life clinical setting are comparable to those reported in clinical trials. Biological therapy reduces exacerbations and per oral corticosteroid use. TRIAL REGISTRATION NCT04158050, retrospectively registered 6.11.2019.
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Affiliation(s)
- Emma Kotisalmi
- Respiratory Diseases and Allergology, University of Helsinki and Helsinki University Hospital, Inflammation Center, Meilahdentie 2, FI-00029 HUS, P.O. Box 160, Helsinki, Finland
- Respiratory Diseases and Allergology, University of Helsinki and Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
| | - Auli Hakulinen
- Respiratory Diseases and Allergology, University of Helsinki and Helsinki University Hospital, Inflammation Center, Meilahdentie 2, FI-00029 HUS, P.O. Box 160, Helsinki, Finland
| | - Mika Mäkelä
- Respiratory Diseases and Allergology, University of Helsinki and Helsinki University Hospital, Inflammation Center, Meilahdentie 2, FI-00029 HUS, P.O. Box 160, Helsinki, Finland
| | - Sanna Toppila-Salmi
- Otorhinolaryngology, University of Helsinki and Helsinki University Hospital, Inflammation Center, Helsinki, Finland
| | - Paula Kauppi
- Respiratory Diseases and Allergology, University of Helsinki and Helsinki University Hospital, Inflammation Center, Meilahdentie 2, FI-00029 HUS, P.O. Box 160, Helsinki, Finland
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Chong L, Piromchai P, Sharp S, Snidvongs K, Philpott C, Hopkins C, Burton MJ. Biologics for chronic rhinosinusitis. Cochrane Database Syst Rev 2020; 2:CD013513. [PMID: 32102112 PMCID: PMC7043934 DOI: 10.1002/14651858.cd013513.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND This living systematic review is one of several Cochrane Reviews evaluating the medical management of patients with chronic rhinosinusitis. Chronic rhinosinusitis is common. It is characterised by inflammation of the nasal and sinus linings, nasal blockage, rhinorrhoea, facial pressure/pain and loss of sense of smell. It occurs with or without nasal polyps. 'Biologics' are medicinal products produced by a biological process. Monoclonal antibodies are one type, already evaluated in related inflammatory conditions (e.g. asthma and atopic dermatitis). OBJECTIVES To assess the effects of biologics for the treatment of chronic rhinosinusitis. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Register; CENTRAL (2019, Issue 9); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 16 September 2019. SELECTION CRITERIA Randomised controlled trials (RCTs) with at least three months follow-up comparing biologics (currently, monoclonal antibodies) against placebo/no treatment in patients with chronic rhinosinusitis. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Our primary outcomes were disease-specific health-related quality of life (HRQL), disease severity and serious adverse events (SAEs). The secondary outcomes were avoidance of surgery, extent of disease (measured by endoscopic or computerised tomography (CT) score), generic HRQL and adverse events (nasopharyngitis, including sore throat). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included eight RCTs. Of 986 adult participants, 984 had severe chronic rhinosinusitis with nasal polyps; 43% to 100% of participants also had asthma. Three biologics, with different targets, were evaluated: dupilumab, mepolizumab and omalizumab. All the studies were sponsored or supported by industry. Anti-IL-4Rα mAb (dupilumab) versusplacebo/no treatment (all receiving intranasal steroids) Three studies (784 participants) evaluated dupilumab. Disease-specific HRQL was measured with the SNOT-22 (score 0 to 110; minimal clinically important difference (MCID) 8.9 points). At 24 weeks, the SNOT-22 score was 19.61 points lower (better) in participants receiving dupilumab (mean difference (MD) -19.61, 95% confidence interval (CI) -22.54 to -16.69; 3 studies; 784 participants; high certainty). Symptom severity measured on a 0- to 10-point visual analogue scale (VAS) was 3.00 lower in those receiving dupilumab (95% CI -3.47 to -2.53; 3 studies; 784 participants; moderate certainty). The risk of serious adverse events may be lower in the dupilumab group (risk ratio (RR) 0.45, 95% CI 0.28 to 0.75; 3 studies; 782 participants; low certainty). The number of participants requiring nasal polyp surgery (actual or planned) during the treatment period is probably lower in those receiving dupilumab (RR 0.17, 95% CI 0.05 to 0.52; 2 studies; 725 participants; moderate certainty). Change in the extent of disease using the Lund Mackay computerised tomography (CT) score (0 to 24, higher = worse) was -7.00 (95% CI -9.61 to -4.39; 3 studies; 784 participants; high certainty), a large effect favouring the dupilumab group. The EQ-5D visual analogue scale (0 to 100, higher = better; MCID 8 points) was used to measure change in generic quality of life. The mean difference favouring dupilumab was 8.59 (95% CI 5.31 to 11.86; 2 studies; 706 participants; moderate certainty). There may be little or no difference in the risk of nasopharyngitis (RR 0.95, 95% CI 0.72 to 1.25; 3 studies; 783 participants; low certainty). Anti-IL-5 mAb (mepolizumab) versusplacebo/no treatment (all receiving intranasal steroids) Two studies (137 participants) evaluated mepolizumab. Disease-specific HRQL measured with the SNOT-22 at 25 weeks was 13.26 points lower (better) in participants receiving mepolizumab (95% CI -22.08 to -4.44; 1 study; 105 participants; low certainty; MCID 8.9). It is very uncertain whether there is a difference in s ymptom severity: on a 0- to 10-point VAS symptom severity was -2.03 lower in those receiving mepolizumab (95% CI -3.65 to -0.41; 1 study; 72 participants; very low certainty). It is very uncertain if there is difference in the risk of serious adverse events (RR 1.57, 95% CI 0.07 to 35.46; 2 studies; 135 participants, very low certainty). It is very uncertain whether or not the overall risk that patients still need surgery at trial end is lower in the mepolizumab group (RR 0.78, 95% CI 0.64 to 0.94; 2 studies; 135 participants; very low certainty). It is very uncertain whether mepolizumab reduces the extent of disease as measured by endoscopic nasal polyps score (scale range 0 to 8). The mean difference was 1.23 points lower in the mepolizumab group (MD -1.23, 95% -1.79 to -0.68; 2 studies; 137 participants; very low certainty). The difference in generic quality of life (EQ-5D) was 5.68 (95% CI -1.18 to 12.54; 1 study; 105 participants; low certainty), favouring the mepolizumab group. This difference is smaller than the MCID of 8 points. There may be little or no difference in the risk of nasopharyngitis (RR 0.73, 95% 0.36 to 1.47; 2 studies; 135 participants; low certainty). Anti-IgE mAb (omalizumab) versus placebo/no treatment (all receiving intranasal steroids) Three very small studies (65 participants) evaluated omalizumab. We are very uncertain about the effect of omalizumab on disease-specific HRQL, severe adverse events, extent of disease (CT scan scores), generic HRQL and adverse effects. AUTHORS' CONCLUSIONS In adults with severe chronic rhinosinusitis and nasal polyps, using regular topical nasal steroids, dupilumab improves disease-specific HRQL compared to placebo, and reduces the extent of the disease as measured on a CT scan. It probably also improves symptoms and generic HRQL and there is no evidence of an increased risk of serious adverse events. It may reduce the need for further surgery. There may be little or no difference in the risk of nasopharyngitis. In similar patients, mepolizumab may improve both disease-specific and generic HRQL. It is uncertain whether it reduces the need for surgery or improves nasal polyp scores. There may be little or no difference in the risk of nasopharyngitis. It is uncertain if there is a difference in symptom severity and the risk of serious adverse events. We are uncertain about the effects of omalizumab.
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Affiliation(s)
| | - Patorn Piromchai
- Faculty of Medicine, Khon Kaen UniversityDepartment of OtorhinolaryngologyKhon KaenThailand
| | - Steve Sharp
- National Institute for Health and Care ExcellenceLevel 1A, City TowerPiccadilly PlazaManchesterUKM1 4BT
| | - Kornkiat Snidvongs
- Chulalongkorn UniversityDepartment of Otolaryngology, Faculty of MedicineBangkokThailand
| | - Carl Philpott
- Norwich Medical School, University of East AngliaDepartment of MedicineNorwichUKNR4 7TJ
| | - Claire Hopkins
- Guy's HospitalENT DepartmentGerat Maze PondLondonUKSE1 9RT
| | - Martin J Burton
- Cochrane UKSummertown Pavilion18 ‐ 24 Middle WayOxfordUKOX2 7LG
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Crisci CD, Ardusso LRF. A Precision Medicine Approach to Rhinitis Evaluation and Management. CURRENT TREATMENT OPTIONS IN ALLERGY 2020; 7:93-109. [PMID: 32226715 PMCID: PMC7099688 DOI: 10.1007/s40521-020-00243-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Precision medicine (PM) represents a new paradigm in disease diagnosis, prevention, and treatment. The PM approach focuses on the characterization of different phenotypes and pathogenic pathways in order to allow the selection of specific biomarkers that will be useful in disease management. Rhinitis is a highly prevalent and heterogeneous disease, both in terms of underlying endotypes and clinical presentations. Therefore, to apply the PM principles to the various rhinitis subtypes rise as a meaningful strategy to improve evaluation and treatment. RECENT FINDINGS The technology of recombinant allergens has allowed molecular characterization of IgE reactivity of specific individual components of allergenic extracts. Recently published and ongoing clinical trials based on component resolved diagnosis (CRD) bring more precision to allergen immunotherapy for allergic rhinitis. Monoclonal antibodies against various cytokines involved in inflammatory allergic and nonallergic rhinitis endotypes show promissory results. SUMMARY Better understanding of pathogenic pathways together with an accurate phenotype classification of patients presented with rhinitis symptoms contributes to point out clinical usefulness of biomarkers and other diagnostic tools, which leads to more accurate environmental control measures, personalized pharmacologic options, and new biological therapy developments.
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Affiliation(s)
- Carlos D. Crisci
- Department of Pulmonology Allergy and Immunology, School of Medicine, National University of Rosario, 2000 Rosario, Santa Fe Argentina
| | - Ledit R. F. Ardusso
- Department of Pulmonology Allergy and Immunology, School of Medicine, National University of Rosario, 2000 Rosario, Santa Fe Argentina
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Tyler MA, Luong AU. Current Concepts in the Management of Allergic Fungal Rhinosinusitis. Immunol Allergy Clin North Am 2020; 40:345-359. [PMID: 32278456 DOI: 10.1016/j.iac.2019.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Allergic fungal rhinosinusitis (AFRS) represents a subtype of chronic rhinosinusitis with nasal polyposis that exhibits a unique, often striking clinical presentation. Since its initial description more than a quarter century ago, a more sophisticated understanding of the pathophysiology of AFRS has been achieved and significant advancements in improving clinical outcomes made. This review focuses on the latest developments involving the pathophysiology and clinical management of this fascinating disease.
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Affiliation(s)
- Matthew A Tyler
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical School, 516 Delaware Street Southeast, # 8A, Minneapolis, MN 55455, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Texas Sinus Institute, 6431 Fannin Street, MSB 5.036, Houston, TX 77030, USA; Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA.
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Patel GB, Kern RC, Bernstein JA, Hae-Sim P, Peters AT. Current and Future Treatments of Rhinitis and Sinusitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1522-1531. [PMID: 32004747 DOI: 10.1016/j.jaip.2020.01.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 02/07/2023]
Abstract
Advances in understanding the pathogenic mechanisms of both rhinitis and chronic rhinosinusitis have resulted in new treatment options, especially for chronic rhinosinusitis. A review of relevant medical and surgical clinical studies shows that intranasal corticosteroids, antihistamines, and allergen immunotherapy continue to be the best treatments for chronic rhinitis. Dupilumab is the first biologic approved for chronic rhinosinusitis with polyps. Omalizumab, mepolizumab, and benralizumab may have a future role in the treatment of chronic rhinosinusitis. Novel corticosteroid delivery devices such as an exhalation delivery system for fluticasone and bioabsorbable sinus implants provide enhanced and localized distribution of corticosteroids. Surgical management tailored to the underlying disease process improves clinical outcomes in chronic rhinosinusitis with or without nasal polyposis. Advances in the understanding of the heterogeneous nature of rhinitis and rhinosinusitis have resulted in more precise treatments. Improving the understanding of different endotypes should provide better knowledge to determine appropriate current and new therapies to treat these diseases.
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Affiliation(s)
- Gayatri B Patel
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert C Kern
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | - Park Hae-Sim
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Anju T Peters
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Hox V, Lourijsen E, Jordens A, Aasbjerg K, Agache I, Alobid I, Bachert C, Boussery K, Campo P, Fokkens W, Hellings P, Hopkins C, Klimek L, Mäkelä M, Mösges R, Mullol J, Pujols L, Rondon C, Rudenko M, Toppila-Salmi S, Scadding G, Scheire S, Tomazic PV, Van Zele T, Wagemann M, van Boven JFM, Gevaert P. Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position paper. Clin Transl Allergy 2020; 10:1. [PMID: 31908763 PMCID: PMC6941282 DOI: 10.1186/s13601-019-0303-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 12/02/2019] [Indexed: 02/05/2023] Open
Abstract
Because of the inflammatory mechanisms of most chronic upper airway diseases such as rhinitis and chronic rhinosinusitis, systemic steroids have been used for their treatment for decades. However, it has been very well documented that—potentially severe—side-effects can occur with the accumulation of systemic steroid courses over the years. A consensus document summarizing the benefits of systemic steroids for each upper airway disease type, as well as highlighting the potential harms of this treatment is currently lacking. Therefore, a panel of international experts in the field of Rhinology reviewed the available literature with the aim of providing recommendations for the use of systemic steroids in treating upper airway disease.
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Affiliation(s)
- Valerie Hox
- 1Cliniques Universitaires Saint-Luc Brussels, Av. Hippocrate 10, 1200 Brussels, Belgium
| | - Evelijn Lourijsen
- 2Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC, Amsterdam, The Netherlands
| | - Arnout Jordens
- 3Upper Airway Research Laboratory, Dep. of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | | | - Ioana Agache
- Faculty of Medicine, Transsylvania University, Brasov, Romania
| | - Isam Alobid
- 6Hospital Clínic, IDIBAPS, CEBERES Universitat de Barcelona, Catalonia, Spain.,7Centro Medico Teknon, Barcelona, Spain
| | - Claus Bachert
- 3Upper Airway Research Laboratory, Dep. of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium.,8Department of Ear, Nose and Throat Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Koen Boussery
- 9Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Paloma Campo
- 10Allergy Unit, Hospital Regional Universitario of Málaga, IBIMA, ARADyAL, Malaga, Spain
| | - Wytske Fokkens
- 2Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC, Amsterdam, The Netherlands
| | - Peter Hellings
- 11Department of Ear, Nose and Throat Disease, University Hospitals, Louvain, Belgium
| | - Claire Hopkins
- 12ENT Department, Guy's & St Thomas' Hospital, London, UK
| | - Ludger Klimek
- Center of Rhinology and Allergology, Wiesbaden, Germany
| | - Mika Mäkelä
- 14Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Joaquim Mullol
- 6Hospital Clínic, IDIBAPS, CEBERES Universitat de Barcelona, Catalonia, Spain
| | - Laura Pujols
- 6Hospital Clínic, IDIBAPS, CEBERES Universitat de Barcelona, Catalonia, Spain
| | - Carmen Rondon
- 10Allergy Unit, Hospital Regional Universitario of Málaga, IBIMA, ARADyAL, Malaga, Spain
| | | | - Sanna Toppila-Salmi
- 14Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Sophie Scheire
- 9Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | | | - Thibaut Van Zele
- 3Upper Airway Research Laboratory, Dep. of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | | | - Job F M van Boven
- 20Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
| | - Philippe Gevaert
- 3Upper Airway Research Laboratory, Dep. of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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Yeung WYW, Park HS. Update on the Management of Nonsteroidal Anti-Inflammatory Drug Hypersensitivity. Yonsei Med J 2020; 61:4-14. [PMID: 31887794 PMCID: PMC6938782 DOI: 10.3349/ymj.2020.61.1.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/01/2019] [Indexed: 12/19/2022] Open
Abstract
The clinical phenotypes of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity are heterogeneous with various presentations including time of symptom onset, organ involvements, and underlying pathophysiology. Having a correct diagnosis can be challenging. Understanding their respective mechanisms as well as developing a comprehensive classification and diagnostic algorithm are pivotal for appropriate management strategy. Treatment modalities are based on the subtypes and severity of hypersensitivity reactions. Insights into the phenotypes and endotypes of hypersensitivity reactions enable personalized management in patients with suboptimal control of disease. This review updated the recent evidence of pathophysiology, classification, diagnostic algorithm, and management of NSAID hypersensitivity reactions.
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Affiliation(s)
- Wan Yin Winnie Yeung
- Division of Rheumatology, Department of Internal Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea.
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Phenotypes and endotypes in eosinophilic esophagitis. Ann Allergy Asthma Immunol 2019; 124:233-239. [PMID: 31862435 DOI: 10.1016/j.anai.2019.12.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/04/2019] [Accepted: 12/08/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To improve understanding of the heterogeneous presentation of eosinophilic esophagitis (EoE), and its different potential phenotypes and endotypes. DATA SOURCES We reviewed studies addressing EoE genetics, risks, natural history, treatment, phenotype, or endotype to assess data relating to differences in the presentation of EoE in children and adults. This review was restricted to articles in the English language. STUDY SELECTIONS Data source abstracts, pertinent articles, and book chapters meeting the objectives were critically reviewed. RESULTS Data to support differing phenotypes and endotypes in EoE are emerging, but findings are based on multiple studies and therefore sometimes incomparable. Like other atopic disorders EoE is a complex disease with diverse clinical presentations (phenotypes) based on response to therapy, natural history, and association with atopic comorbidities. Different pathogenetic mechanisms (endotypes) may drive the multiple phenotypes. T Helper type 2 inflammation, epithelial barrier defects, enhanced fibrosis, and association with rare monogenetic diseases are the most described endotypes in EoE. CONCLUSION Eosinophilic esophagitis is an atopic disorder that is increasing in prevalence and can be difficult to treat. Better understanding of phenotypes and endotypes in EoE may enable future care to be individualized more effectively, resulting in shorter time to remission and fewer endoscopies.
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Lou H, Wang C, Zhang L. Endotype-driven precision medicine in chronic rhinosinusitis. Expert Rev Clin Immunol 2019; 15:1171-1183. [PMID: 31600458 DOI: 10.1080/1744666x.2020.1679626] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Hongfei Lou
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Chengshuo Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
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Mast cells drive IgE-mediated disease but might be bystanders in many other inflammatory and neoplastic conditions. J Allergy Clin Immunol 2019; 144:S19-S30. [DOI: 10.1016/j.jaci.2019.07.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/11/2019] [Accepted: 07/08/2019] [Indexed: 01/05/2023]
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Shoda Y, Watanabe M, Wada K, Soutome T, Komine Y, Mikami T, Nemoto T, Ohara A. Successful management of severe asthma in a young boy with eosinophilic chronic rhinosinusitis who received omalizumab: a case report. Allergy Asthma Clin Immunol 2019; 15:55. [PMID: 31516504 PMCID: PMC6728995 DOI: 10.1186/s13223-019-0369-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/27/2019] [Indexed: 12/19/2022] Open
Abstract
Background The incidence of chronic rhinosinusitis with nasal polyps has recently increased in Japan and other East Asian countries, and this disease is called eosinophilic chronic sinusitis (ECRS) in Japan. ECRS usually occurs in adults and is frequently accompanied by refractory bronchial asthma. However, its occurrence in children under 10 years of age is rare. Here, we present an unusual case of ECRS complicated by intractable asthma in an 8-year-old boy. Case presentation Oral administration of prednisolone (10 mg/day) initially relieved the ECRS and bronchial asthma, but both returned during prednisolone dose reduction. Because nasal cavity-opening surgery was ineffective, oral administration prednisolone at 10 mg/day was continued. Pancytopenia was observed 16 months after the start of treatment, and the patient was admitted to our hospital. He was diagnosed with refractory cytopenia in childhood, but gradually improved after cyclosporine treatment. Although the dose of cyclosporine was therapeutic for asthma, it did not alleviate the asthma attacks, and the patient’s quality of life markedly decreased. We administered omalizumab even though its use was contraindicated by negative results in an inhalable antigen test. After the third administration of omalizumab, the asthma was better controlled and respiratory function improved; however, the nasal symptoms of ECRS persisted. Attempts to relieve these symptoms by increasing the therapeutic dose of omalizumab were only partially successful. We replaced omalizumab with mepolizumab; doing so slightly improved the sinusitis symptoms, but quality of life remained unsatisfactory. We repeated the nasal cavity-opening surgery. After surgery, the asthma and sinusitis were unchanged. Conclusions Omalizumab effectively treated the severe combined asthma in a young patient, but its effect on sinusitis was insufficient. More cases and long-term follow-up data are needed to better evaluate the effectiveness of mepolizumab for treatment of ECRS.
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Affiliation(s)
- Yasuho Shoda
- 1Department of Pediatrics, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541 Japan
| | - Misa Watanabe
- 1Department of Pediatrics, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541 Japan
| | - Kota Wada
- 2Department of Otolaryngology, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541 Japan
| | - Takehiko Soutome
- 1Department of Pediatrics, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541 Japan
| | - Yumiko Komine
- 1Department of Pediatrics, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541 Japan
| | - Tetsuo Mikami
- 3Department of Pathology, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541 Japan
| | - Tetsuo Nemoto
- 3Department of Pathology, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541 Japan.,4Department of Pathology, Showa University School of Medicine, Yokohama Northern Hospital, 35-1 Chigasaki-Chuo, Tsuzuki-ku, Yokohama, Kanagawa, 224-8503 Japan
| | - Akira Ohara
- 1Department of Pediatrics, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541 Japan
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Cavaliere C, Frati F, Ridolo E, Greco A, de Vincentiis M, Masieri S, Makri E, Incorvaia C. The spectrum of therapeutic activity of mepolizumab. Expert Rev Clin Immunol 2019; 15:959-967. [PMID: 31424304 DOI: 10.1080/1744666x.2019.1656065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: The basis of the development of the anti-interleukin-5 monoclonal antibody mepolizumab was the acknowledgment of the crucial importance of this cytokine in promoting eosinophils production, activation, and survival, which is associated with the eosinophilic asthma phenotype, as well as with other disorders characterized by high levels of eosinophils. Areas covered: All the available literature on the outcomes treatment with mepolizumab in eosinophilic disorders are reviewed, including asthma, chronic rhinosinusitis, esophagitis, granulomatosis with polyangiitis, eosinophilic chronic obstructive pulmonary disease, hypereosinophilic syndrome, and allergic bronchopulmonary aspergillosis. Expert opinion: The efficacy of mepolizumab in eosinophilic asthma is clearly demonstrated by a number of controlled trials and by meta-analyses. Among other eosinophilic disorders, controlled trials are available for chronic rhinosinusitis with nasal polyps, eosinophilic esophagitis, hypereosinophilic syndrome, eosinophilic granulomatosis with polyangiitis, and eosinophilic chronic obstructive pulmonary disease. Allergic bronchopulmonary aspergillosis, as well as other minor eosinophilic disorders, are backed only by case reports and are waiting controlled trials to verify the therapeutic role of mepolizumab.
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Affiliation(s)
- Carlo Cavaliere
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome , Rome , Italy
| | - Franco Frati
- Pediatric allergy Private Practice , Camucia (AR) , Italy
| | - Erminia Ridolo
- Allergy and Clinical Immunology, Medicine and Surgery Department, University of Parma , Parma , Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome , Rome , Italy
| | | | - Simonetta Masieri
- Department of Sense Organs, Sapienza University of Rome , Rome , Italy
| | - Eleni Makri
- Cardiac/Pulmonary Rehabilitation, ASST Pini/CTO , Milan , Italy
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Konstantinou GN, Kaitalidou E, Skoulikaris N. Sublingual immunotherapy and omalizumab cured allergic chronic rhinosinusitis and asthma: coincidence or synergistic effect? Ann Allergy Asthma Immunol 2019; 123:440-443. [PMID: 31445089 DOI: 10.1016/j.anai.2019.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/11/2019] [Accepted: 08/14/2019] [Indexed: 11/24/2022]
Affiliation(s)
- George N Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece.
| | - Elisavet Kaitalidou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Nikolaos Skoulikaris
- Department of Radiology, 424 General Military Training Hospital, Thessaloniki, Greece
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Wahba AA, Abdelfattah AM. Anti-immunoglobulin E therapy: is it a valid option for the management of chronic rhinosinusitis with nasal polyposis? THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2019. [DOI: 10.4103/ejo.ejo_19_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Flora M, Perrotta F, Nicolai A, Maffucci R, Pratillo A, Mollica M, Bianco A, Calabrese C. Staphylococcus Aureus in chronic airway diseases: An overview. Respir Med 2019; 155:66-71. [PMID: 31302581 DOI: 10.1016/j.rmed.2019.07.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 06/22/2019] [Accepted: 07/05/2019] [Indexed: 02/06/2023]
Abstract
This review investigates about the role of Staphylococcus Aureus (S. aureus) and S. aureus enterotoxins (SEs) in the pathogenesis of several chronic airway diseases. S. aureus is part of normal human flora and may colonize the skin and the upper airways. SEs acting as superantigens can induce an intense T cell activation and through the release of interleukin (IL) - 4, 5, and 13, can promote a polyclonal IgE response and eosinophilic inflammation. S. aureus can damage epithelial cells inducing the release of the so-called "alarmins" responsible of the activation of Type 2 innate lymphoid cells (ILC-2) linked to an IL-5 mediated airway eosinophilic inflammation. SEs sensitization has been recently associated with the eosinophilic endotypes of both nasal polyps and late onset severe asthma. Studies investigating the effect of biological therapies in SEs sensitized patients should be performed in order to better define the role played by S. aureus in the different endotypes of severe asthma and/or chronic rhinosinusitis.
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Affiliation(s)
- Martina Flora
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Italy
| | - Fabio Perrotta
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Italy
| | - Ambra Nicolai
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Italy
| | - Rosalba Maffucci
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Italy
| | - Anna Pratillo
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Italy
| | - Mariano Mollica
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Italy
| | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Italy
| | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Italy.
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Panda SK, Colonna M. Innate Lymphoid Cells in Mucosal Immunity. Front Immunol 2019; 10:861. [PMID: 31134050 PMCID: PMC6515929 DOI: 10.3389/fimmu.2019.00861] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/03/2019] [Indexed: 12/14/2022] Open
Abstract
Innate lymphoid cells (ILCs) are innate counterparts of T cells that contribute to immune responses by secreting effector cytokines and regulating the functions of other innate and adaptive immune cells. ILCs carry out some unique functions but share some tasks with T cells. ILCs are present in lymphoid and non-lymphoid organs and are particularly abundant at the mucosal barriers, where they are exposed to allergens, commensal microbes, and pathogens. The impact of ILCs in mucosal immune responses has been extensively investigated in the gastrointestinal and respiratory tracts, as well as in the oral cavity. Here we review the state-of-the-art knowledge of ILC functions in infections, allergy and autoimmune disorders of the mucosal barriers.
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Affiliation(s)
- Santosh K Panda
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Marco Colonna
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
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45
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Maniscalco M, Calabrese C, D'Amato M, Guida P, Molino A, Aliani M, De Tullio R, Foschino Barbaro M, Ricciardolo FLM, Carpagnano GE. Association between exhaled nitric oxide and nasal polyposis in severe asthma. Respir Med 2019; 152:20-24. [PMID: 31128605 DOI: 10.1016/j.rmed.2019.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/09/2019] [Accepted: 04/21/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although several contributions exist on the role of fractional exhaled NO (FeNO) in diagnosis and management of asthma, no studies have analysed the association between FeNO in patients with severe asthma and nasal polyposis. AIM We investigated the potential association between FeNO and the presence of nasal polyps in patients affected by severe asthma. METHODS Study population included 93 severe asthmatic adult patients consecutively enrolled from four Italian specialist clinic centres from 2015 to 2018. In these patients lung function, asthma control, FeNO, blood eosinophils and CT scan of paranasal sinuses were evaluated. RESULTS Nasal polyposis was observed in 28 patients (30%). Among univariate predictors (lower BMI, higher FeNO, eosinophil and neutrophil count), recursive partitioning analysis identified as best predictors of nasal polyposis high values of eosinophil count (≥6.5% or >420 cells/mm3) and FeNO (≥39 ppb). The 40 patients with low eosinophil count and FeNO had a significant lower occurrence of nasal polyposis than those with higher values (8% vs 58%; p < 0.001). The stratification algorithm had a good performance in discriminate patients with and without nasal polyposis (area under the receiver operating characteristic curve of 0.768). CONCLUSIONS Our results show that FeNO might improve to detect nasal polyposis in patients with severe asthma and a low level of blood eosinophils counts, identifying individuals with high susceptibility to this condition.
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Affiliation(s)
- Mauro Maniscalco
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA, IRCCS, Telese Terme, Benevento, Italy.
| | - Cecilia Calabrese
- Department of Respiratory Medicine, University Federico II, Naples, Italy
| | - Maria D'Amato
- Department of Respiratory Medicine, University Federico II, Naples, Italy
| | - Pietro Guida
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA, IRCCS, Telese Terme, Benevento, Italy
| | - Antonio Molino
- Department of Respiratory Medicine, University Federico II, Naples, Italy
| | - Maria Aliani
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA, IRCCS, Cassano Delle Murge, Bari, Italy
| | - Renato De Tullio
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA, IRCCS, Cassano Delle Murge, Bari, Italy
| | - Mariapia Foschino Barbaro
- Institute of Respiratory Diseases, Department of Medical and Surgical Sciences, University of Foggia, Italy
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Cavaliere C, Incorvaia C, Frati F, Messineo D, Ciotti M, Greco A, de Vincentiis M, Masieri S. Recovery of smell sense loss by mepolizumab in a patient allergic to Dermatophagoides and affected by chronic rhinosinusitis with nasal polyps. Clin Mol Allergy 2019; 17:3. [PMID: 30804712 PMCID: PMC6373033 DOI: 10.1186/s12948-019-0106-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/05/2019] [Indexed: 02/01/2023] Open
Abstract
Background Chronic rhinosinusitis with nasal polyps (CRSwNP) frequently presents with dysfunction or loss of the sense of smell, resulting in a significant impairment in quality of life. The medical treatments currently available may improve the olfactory function in patients with CRSwNP, but such an outcome is generally only transitory. We report the case of a patient with CRSwNP who completely recovered from smell sense loss by treatment with mepolizumab. Case presentation The patient was a 62-year-old female who has severe asthma induced by allergy to Dermatophagoides and concomitant CRSwNP. Any treatment for the latter, including oral and injective corticosteroids, was unsuccessful in the loss of smell. Due to the satisfaction of admission criteria to mepolizumab treatment for severe asthma, treatment was initiated on March 2018, resulting in good clinical control of both asthma and CRSwNP, and particularly in complete recovery of the smell loss after 4 months of treatment and still persisting. Conclusion In this case report, the treatment with mepolizumab in a patient allergic to Dermatophagoides and affected by CRSwNP was associated with an improvement of anosmia. That finding may be explained by a reduction of the nasal obstruction by nasal polyps.
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Affiliation(s)
- Carlo Cavaliere
- 1Department of Oral and Maxillofacial Sciences, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | | | | | - Daniela Messineo
- 4Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Rome, Italy
| | - Mario Ciotti
- 4Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Rome, Italy
| | - Antonio Greco
- 5Department of Sense Organs, Sapienza University, Rome, Italy
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Solidoro P, Patrucco F, de Blasio F, Brussino L, Bellocchia M, Dassetto D, Pivetta E, Riccio A, Heffler E, Canonica W, Rolla G, Bucca C. Predictors of reversible airway obstruction with omalizumab in severe asthma: a real-life study. Ther Adv Respir Dis 2019; 13:1753466619841274. [PMID: 31002021 PMCID: PMC6475845 DOI: 10.1177/1753466619841274] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/18/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Omalizumab may modulate airway remodeling in severe asthma. Using forced expiratory volume in 1 second (FEV1) as a surrogate of airway remodeling, we aimed to investigate if an omalizumab add-on in severe allergic asthma may lead to a persistent reversal of airway obstruction and to evaluate the potential biomarkers of airway obstruction reversibility. METHODS Data were collected before (T0) and after omalizumab add-on for 1 year (T1, 32 patients), 2 years (T2, 26 patients) and 4 years (T4, 13 patients). All patients had baseline FEV1 below 80 % predicted (60.5 ± 12.5 %). After omalizumab, 18 patients showed FEV1 normalization (reversible airway obstruction; RAO+) already at T1 (88.7 ± 14.9 %, p < 0.0001) that persisted up to T4 (83.2 ± 7.9, p < 0.01), while 14 patients (RAO-) had FEV1 persistently decreased, from T1 (65.2 ± 8.4%, p < 0.05) up to T4 (61.4 ± 6.2%, not significant). Both groups had significant improvement of symptoms and exacerbations after omalizumab at T1, which persisted up to T4. The comparison between pretreatment characteristics of the two groups showed that RAO+ patients, had higher values of circulating eosinophils, exhaled nitric oxide (FENO), prevalence of rhinitis and nasal polyps, need of oral corticosteroids, shorter asthma duration, higher FEV1 and response to albuterol test. The optimal cut-off points predicting FEV1 normalization after omalizumab add-on were 30.5 ppb for FENO and 305 cells/µl for eosinophils. CONCLUSIONS This study suggests that omalizumab add-on contributes to the persistent reversal of airway obstruction in a consistent number of patients with severe allergic asthma, and this beneficial effect is predicted by elevated pretreatment FENO and circulating eosinophils.
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Affiliation(s)
- Paolo Solidoro
- S.C. Pneumologia U, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Filippo Patrucco
- S.C. Pneumologia U, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | | | - Luisa Brussino
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Michela Bellocchia
- S.C. Pneumologia U, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Davide Dassetto
- S.C. Pneumologia U, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Emanuele Pivetta
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Annamaria Riccio
- Respiratory Diseases and Allergy Unit, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Enrico Heffler
- Personalised Medicine Clinic Asthma & Allergy, Humanitas University, Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Walter Canonica
- Personalised Medicine Clinic Asthma & Allergy, Humanitas University, Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanni Rolla
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Caterina Bucca
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14 10126 Turin, Italy
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Kartush AG, Schumacher JK, Shah R, Patadia MO. Biologic Agents for the Treatment of Chronic Rhinosinusitis With Nasal Polyps. Am J Rhinol Allergy 2018; 33:203-211. [PMID: 30587005 DOI: 10.1177/1945892418814768] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyposis is a complex inflammatory disorder, which is often recalcitrant to medical and surgical management. Recently, biologic agents have been studied as an adjunct treatment for this patient population. OBJECTIVE The purpose of this study is to examine the role of biologic agents for chronic rhinosinusitis patients by reviewing literature and clinical trials. METHODS A comprehensive review of literature and clinical trials-both recently completed and ongoing-was undertaken to examine up-to-date evidence of current biologic therapy and its role in chronic rhinosinusitis patients-including anti-IgE, anti-IL-4, anti-IL-5, anti-IL-13, and GATA-3 DNAzyme. RESULTS Specific biologic agents discussed include omalizumab, reslizumab, mepolizumab, benralizumab, dupilumab, and Hgd40/SB010. Risks, side effects, and administration information are also reviewed. An algorithm for the use of biologics in patients with chronic rhinosinusitis with nasal polyposis is proposed. CONCLUSION These treatments have promising results and may prove to be an important adjunct for patients with recalcitrant sinus disease.
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Affiliation(s)
- Alison G Kartush
- 1 Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Jane K Schumacher
- 2 Department of Internal Medicine. Affiliate clinician: Loyola University Medical Center, Maywood, Illinois
| | - Rachna Shah
- 1 Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Monica O Patadia
- 1 Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois
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Tiotiu A, Plavec D, Novakova S, Mihaicuta S, Novakova P, Labor M, Bikov A. Current opinions for the management of asthma associated with ear, nose and throat comorbidities. Eur Respir Rev 2018; 27:27/150/180056. [PMID: 30463872 DOI: 10.1183/16000617.0056-2018] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/03/2018] [Indexed: 11/05/2022] Open
Abstract
Ear, nose and throat (ENT) comorbidities are common in patients with asthma and are frequently associated with poorer asthma outcomes. All these comorbidities are "treatable traits" in asthma. Identification and management of these disorders may spare medication usage and contribute to improved asthma control and quality of life, and a decrease in exacerbation rates.This review summarises recent data about the prevalence, clinical impact and treatment effects of ENT comorbidities in asthma including allergic rhinitis, chronic rhinosinusitis with and without nasal polyposis, aspirin-exacerbated respiratory disease, obstructive sleep apnoea and vocal cord dysfunction.Many of these comorbidities are possible to be managed by the pulmonologist, but the collaboration with the ENT specialist is essential for patients with chronic rhinosinusitis or vocal cord dysfunction. Further rigorous research is needed to study the efficacy of comorbidity treatment to improve asthma outcomes, in particular with the development of biotherapies in severe asthma that can also be beneficial in some ENT diseases.
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Affiliation(s)
- Angelica Tiotiu
- Pulmonology Dept, University Hospital, Nancy, France .,EA 3450 DevAH, Development, Adaptation, Cardio-Respiratory Regulations and Motor Control, University of Lorraine, Nancy, France
| | | | - Silviya Novakova
- Allergy Unit, University Hospital "St. George", Plovdiv, Bulgaria
| | | | - Plamena Novakova
- Dept of Allergology and Asthma, Aleksandrovska Hospital, Sofia, Bulgaria
| | - Marina Labor
- Pulmonology Dept, University Hospital Centre Osijek, Osijek, Croatia
| | - Andras Bikov
- NIHR Clinical Research Facility, Manchester University NHS Foundation Trust, Manchester, UK
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Immunomodulators in chronic rhinosinusitis. World J Otorhinolaryngol Head Neck Surg 2018; 4:186-192. [PMID: 30506050 PMCID: PMC6251964 DOI: 10.1016/j.wjorl.2018.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/27/2018] [Indexed: 02/07/2023] Open
Abstract
Objective To provide new insight into how chronic rhinosinusitis (CRS) is conceptualized and treated with a focus on immunomodulator therapy. Data sources Pubmed, Medline, and Embase. Methods A current review of the evidence is provided for immunomodulators investigated for treatment of CRS with nasal polyps (CRSwNP). Results Biologic therapies targeting IgE, IL-4, IL-5, and IL-13 for the treatment of CRSwNP have shown promise and are currently in phase 3 trials. Anti-immunoglobin E (IgE) therapy with omalizumab was assessed in 6 studies, anti-interleukin (IL)-5 therapy in 3 studies (2 mepolizumab, 1 reslizumab) and anti IL-4/IL-13 (dupilumab) therapy in one study. Studied outcomes varied, but the majority of trials identified clinical benefit of therapy over placebo. Other potential targets include thymic stromal lymphopoetin (TSLP), IL-25, IL-33, and sialic acid-binding immunoglobulin-type lectin (Siglec)-8. Small molecule drugs that target the dysregulation of the immune system in CRS are also being investigated for their immunomodulatory effects on inflammation. Conclusion Immunomodulator therapies for CRS currently in development will likely provide another therapeutic option for patients who have severe disease unresponsive to corticosteroids and surgery. Targeted monoclonal antibody therapies have shown encouraging results and phase 3 trials are underway. IL-4/IL-13 inhibition has shown the most promise to date. Further larger, well-designed trials are needed to improve understanding of these molecules and to offer endotype-driven therapies in the management of CRS. None of these therapeutics have shown long-term immunomodulation when discontinued and therefore further investigation into the pathomechanism of disease continues to be needed.
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