TY - JOUR
T1 - Endotypes of Chronic Rhinosinusitis with Nasal Polyps
T2 - Pathology and Possible Therapeutic Implications
AU - Bachert, Claus
AU - Marple, Brad
AU - Hosemann, Werner
AU - Cavaliere, Carlo
AU - Wen, Weiping
AU - Zhang, Nan
N1 - Publisher Copyright:
© 2020 American Academy of Allergy, Asthma & Immunology
PY - 2020/5
Y1 - 2020/5
N2 - Today, chronic rhinosinusitis (CRS) is a symptomatic disease diagnosed by nasal endoscopy and eventually computed tomography scan, and is treated by pharmacotherapy or, when unsuccessful, by sinus surgery. With the advent of biologics, the diagnostic approach needs to be adjusted to appreciate CRS endotypes, introducing biomarkers, and the therapeutic options will be extended by the application of biologics. Specifically, type 2 immune reactions moved into the focus, similar to asthma, involving innate and adaptive immunity pathways to establish an often severe, persistent disease. The role for endotyping of CRS became evident for biologics, but also turned out to be meaningful for the decision on the selection of pharmacotherapy and the specific surgical approach to choose. Furthermore, considerations on the role of surgery and biologics needed to be elaborated to develop decision-making processes for patients with moderate-to-severe CRS with nasal polyps, with or without comorbid asthma, allowing us to adjust the treatment for patient groups based on endotyping (precision medicine). We here aim to guide the decisions in a rational way based on the current knowledge of the efficacy and complications or side effects of the recently enlarged therapeutic options. Personal experience has been added where knowledge was lacking in this fast moving field.
AB - Today, chronic rhinosinusitis (CRS) is a symptomatic disease diagnosed by nasal endoscopy and eventually computed tomography scan, and is treated by pharmacotherapy or, when unsuccessful, by sinus surgery. With the advent of biologics, the diagnostic approach needs to be adjusted to appreciate CRS endotypes, introducing biomarkers, and the therapeutic options will be extended by the application of biologics. Specifically, type 2 immune reactions moved into the focus, similar to asthma, involving innate and adaptive immunity pathways to establish an often severe, persistent disease. The role for endotyping of CRS became evident for biologics, but also turned out to be meaningful for the decision on the selection of pharmacotherapy and the specific surgical approach to choose. Furthermore, considerations on the role of surgery and biologics needed to be elaborated to develop decision-making processes for patients with moderate-to-severe CRS with nasal polyps, with or without comorbid asthma, allowing us to adjust the treatment for patient groups based on endotyping (precision medicine). We here aim to guide the decisions in a rational way based on the current knowledge of the efficacy and complications or side effects of the recently enlarged therapeutic options. Personal experience has been added where knowledge was lacking in this fast moving field.
KW - Biologics
KW - Chronic rhinosinusitis
KW - Endotypes
KW - Nasal polyps
KW - Surgery
KW - Type 2 inflammation
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U2 - 10.1016/j.jaip.2020.03.007
DO - 10.1016/j.jaip.2020.03.007
M3 - Article
C2 - 32217158
AN - SCOPUS:85082801024
SN - 2213-2198
VL - 8
SP - 1514
EP - 1519
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 5
ER -