Analysis of Histopathological Endotyping for Chronic Rhinosinusitis Phenotypes Based on Comorbid Asthma and Allergic Rhinitis

Abstract

Background An emerging trend in clinical research has centered on improving the characteristics of chronic rhinosinusitis (CRS) according to phenotypes and endotypes. The objective of this study is to utilize histopathological markers to better characterize CRS phenotypes that are defined by the presence or absence of comorbid bronchial asthma (BA) and allergic rhinitis (AR). Methods A prospective case-controlled study of CRS patients was conducted. For the CRS cohort, mucosal biopsies were obtained during endoscopic sinus surgery, while samples of ethmoid mucosa were collected in control patients undergoing endoscopic skull base surgery. Histopathological analysis of tissue samples determined the relative frequency of inflammatory cell types, including eosinophils, lymphocytes, neutrophils, mast cells, and plasma cells. The presence and absence of comorbid BA and AR were used to further divide CRS, allowing for further subgroup analysis. Results Of 82 recruited patients, there were 67 CRS patients and 15 controls. Significantly increased eosinophil ratios were found in CRS patients with AR, BA, or both, when compared with controls ( P < .001). Conversely, CRS patients with neither comorbid diagnosis failed to demonstrate statistically significant elevations in eosinophil ratios ( P > .05). Lymphocyte ratios showed a significantly inverse correlation with trends demonstrated by eosinophil ratios in all patient subgroups ( P < .001). Neutrophil, mast cell, and plasma cell ratios did not show significant differences across the evaluated subgroups. Conclusions The clinical diagnosis of comorbid BA and AR may aid in better characterizing CRS endotypes without invasive testing and better direct management of the disease.

Central compartment atopic disease: prevalence of allergy and asthma compared with other subtypes of chronic rhinosinusitis with nasal polyps

“…Furthermore, comorbid AR and asthma may predict severity of disease and increased symptom burden . A recent prospective case‐control study demonstrated that CRSwNP with comorbid AR and asthma was associated with increased eosinophil ratios and a higher risk of polyp recurrence . Therefore, it is necessary to obtain a thorough allergy and asthma history when CRSwNP is identified.…”

Emerging Contribution of Histopathology to Our Understanding of Chronic Rhinosinusitis Endotypes: Tissue Eosinophil Count and Aggregates

“…Radabaugh et al. 9 found mean eosinophil cellularity higher in CRS associated with both allergic rhinitis and bronchial asthma, followed by CRS associated only with bronchial asthma, then CRS with allergic rhinitis. A high tissue eosinophilia in CRS is generally considered prognostically important.…”

“…In CRS, it has been noted that tissue eosinophilia is related to certain associated clinical features, such as allergy, asthma, NSAID hypersensitivity, and blood eosinophilia and basophilia. 2 Very recently, Radabaugh et al 9 investigated several histopathological variables (including eosinophils, lymphocytes, neutrophils, mast cells, and plasma cells) to better endotype CRSwNP based on the presence/ absence of bronchial asthma and allergic rhinitis. Radabaugh et al 9 found mean eosinophil cellularity higher in CRS associated with both allergic rhinitis and bronchial asthma, followed by CRS associated only with bronchial asthma, then CRS with allergic rhinitis.…”

“…2 Very recently, Radabaugh et al. 9 investigated several histopathological variables (including eosinophils, lymphocytes, neutrophils, mast cells, and plasma cells) to better endotype CRSwNP based on the presence/absence of bronchial asthma and allergic rhinitis. Radabaugh et al.…”

Update in Rhinology and Allergy

“…Radabaugh et al found that clinical diagnosis of comorbid bronchial asthma or allergic rhinitis (AR) in CRS patients correlated with increased tissue eosinophil ratios on biopsy, indicating we may be able to use these clinical features rather than invasive testing to characterize CRS histopathologic endotypes. 1 The contribution of AR to the pathogenesis of CRS is not clear. Anamika et al examined the effect of comorbid AR in children with CRS and found that those with AR had increased disease severity in terms of Lund Mackay endoscopic score and worse quality of life.…”