Rethinking chronic rhinosinusitis phenotypes

T helper 2 inflammatory markers are associated with recurrence in chronic rhinosinusitis with nasal polyps after endoscopic sinus surgery

“…Although CRSwNP has been considered and treated as one single clinical disease entity, biological evidence gathered during the last ten years highlights that CRSwNP should be considered a group of different immunologic entities. To fully implement precision medicine into daily practice, disease management for CRSwNP needs to be complemented with inflammatory endotyping (7) . Recent introduction of monoclonal antibodybased therapeutics that target IL-4/IL-13 and IL-5 have shown great promise for managing recalcitrant CRSwNP and may be soon considered valid alternatives to endoscopic sinus surgery (13,14) .…”

“…A single-center prospective longitudinal study included patients with CRSwNP diagnosed according to the 2012 European position paper on rhinosinusitis and nasal polyps guidelines (1) , aged over 18 years, resistant to medical treatment, for whom endoscopic sinus surgery (ESS) was indicated. Refractory CRSwNP was defined by persistent subjectively disabling symptomatology (visual analogic scale for symptom discomfort over (7) , with 10…”

“…In European population, CRSwNP is mainly considered to be orchestrated by T helper (Th) 2 cells, with interleukin (IL)-5 as the major cytokine, resulting in an eosinophilic type of inflammation, associated with local IgE production (5) . However, the extent of eosinophilia can be quite variable as some patients show a Th1/Th17 polarization, characterized by low eosinophilic cationic protein (ECP) levels, the main degranulation product of eosinophils involved in tissue remodeling (6,7) . Tomassen et al characterized 10 potential CRS endotypes based on cluster analysis of different inflammatory mediators within surgical tissue specimen (8) .…”