ICON: chronic rhinosinusitis

Abstract

Chronic rhinosinusitis (CRS) is a public health problem that has a significant socio-economic impact. Moreover, the complexity of this disease due to its heterogeneous nature based on the underlying pathophysiology - leading to different disease variants - further complicates our understanding and directions for the most appropriate targeted treatment strategies. Several International/national guidelines/position papers and/or consensus documents are available that present the current knowledge and treatment strategies for CRS. Yet there are many challenges to the management of CRS especially in the case of the more severe and refractory forms of disease. Therefore, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), a collaboration between EAACI, AAAAI, ACAAI, and WAO, has decided to propose an International Consensus (ICON) on Chronic Rhinosinusitis. The purpose of this ICON on CRS is to highlight the key common messages from the existing guidelines, the differences in recommendations as well as the gaps in our current knowledge of CRS, thus providing a concise reference. In this document we discuss the definition of the disease, its relevance, pharmacoeconomics, pathophysiology, phenotypes and endotypes, genetics and risk factors, natural history and co-morbidities as well as clinical manifestations and treatment options in both adults and children comprising pharmacotherapy, surgical interventions and more recent biological approaches. Finally, we have also highlighted the unmet needs that wait to be addressed through future research.

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…Investigators have nevertheless suggested a number of candidate genes associated with CRS, which has led to some interesting observations with intriguing implications. Reviews of genetics of CRS [615][616][617] have been presented elsewhere and identified genes are presented as a tabulated list (Table VII- 10).…”

“…The most common symptom is nasal obstruction. 617 These symptoms are highly sensitive individually, but not specific. 655,656 Evidence has shown combining 2 or more symptoms together along with objective findings of disease (imaging, endoscopy) substantially increases diagnostic specificity and positive predictive value.…”

Prevalence of Chronic Rhino Sinusitis and It's Recurrent After Treatment Compare to Its Recurrent After Surgery at Saudi Arabia, 2016.

“…As a consequence a wide range of medical and surgical therapies have been used to treat CRS. (6)(7) researches evaluating the comparative efficiency of various treatments for chronic rhinosinusitis (CRS) is scanty.…”

Quantitative analysis of Staphylococcal enterotoxin B expression and its levels in patients with chronic rhinosinusitis with or without nasal polyps

“…[2] Chronic rhinosinusitis with NP is considered a more severe form of the disease with comorbid diseases and more frequent recurrences despite intensive medical and surgical treatment. [3] Fungi, bacteria, viruses, or their associated products may play a role in initiating or perpetuating abnormal and excessive mucosal inflammation. [4] The interaction between Staphylococcus aureus (S. aureus) and the sinonasal mucosa have been studied previously and invasion of the epithelium of the nasal mucosa by S. aureus has been identified by Sache et al [5,6] Whether the microorganism is located within the epithelial cells or not, S. aureus is capable of the formation of a T helper 2 (Th2) mediated cytokine pattern which leads to CRS with NP.…”