Management of patients with chronic rhinosinusitis and nasal polyposis in Italy: expert opinion on the diagnostic-therapeutic approach

Authors

  • Francesco Menzella UOC Pneumologia Distretto di Asolo – AULSS2 Marca Trevigiana, Treviso - Italy https://orcid.org/0000-0003-3950-5789
  • Diego Bagnasco Centro Asma Grave, IRCCS Policlinico San Martino, Genova - Italy https://orcid.org/0000-0002-3661-5731
  • Maria Beatrice Bilò Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona - Italy and Allergologia, Azienda Ospedaliero-Universitaria delle Marche, Ancona - Italy
  • Marco Caminati Allergologia Asma e Immunologia Clinica – Dipartimento di Medicina Università di Verona, Verona - Italy
  • Carlo Cavaliere Dipartimento di Organi di Senso, Sapienza Università di Roma, Roma - Italy https://orcid.org/0000-0002-0378-8935
  • Marco Contoli Malattie Apparato Respiratorio – Dipartimento di Medicina Traslazionale Università di Ferrara, Ferrara - Italy
  • Alessio De Massimi UOS di Otorinolaringoiatria, Servizio di Rinologia e Chirurgia endoscopica naso-sinusale – Azienda Sanitaria Friuli Occidentale, Ospedale San Vito al Tagliamento, San Vito al Tagliamento, Pordenone - Italy https://orcid.org/0000-0002-7244-4423
  • Stefania Gallo Clinica Otorinolaringoiatrica, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese - Italy and UPLOAD Research Center, Università degli Studi dell’Insubria, Varese - Italy
  • Andrea Matucci Allergologia – Ospedale Careggi di Firenze, Firenze - Italy
  • Giancarlo Ottaviano Otorinolaringoiatria – Ospedale Università di Padova, Padova - Italy https://orcid.org/0000-0003-2433-4761
  • Oliviero Rossi Allergologia – Ospedale Careggi di Firenze, Firenze - Italy
  • Veronica Seccia UO Otorinolaringoiatria Audiologia Foniatria Universitaria – Azienda Ospedaliero-Universitaria Pisana, Pisa - Italy https://orcid.org/0000-0002-6297-8034
  • Martino Emmi Novartis Farma, Milan - Italy https://orcid.org/0009-0009-3487-2732
  • Frank Rikki Canevari IRCCS Ospedale Policlinico San Martino, Genova - Italy and IRCCS Ospedale Policlinico San Martino, Genova - Italy https://orcid.org/0000-0002-1821-7262

DOI:

https://doi.org/10.33393/ao.2023.2555

Keywords:

Biological drugs, Chronic rhinosinusitis with nasal polyps, CRSwNP, Nasal polyposis, QoL, Quality of life, Systemic steroids

Abstract

Chronic rhinosinusitis (CRS) is an inflammatory disease that affects the nasal mucosa and the paranasal sinuses; it can be characterized by nasal polyposis (CRSwNP) in up to 30% of cases. CRSwNP is frequently associated with bronchial asthma and patients affected show a greater severity of clinical disease with a significantly worse quality of life.

CRSwNP shows predominantly an underlying activation of type 2 inflammatory pathways with the increase of eosinophils, IgE, interleukin (IL)-4, IL-5 and IL-13. Biological drugs that target inflammatory molecules are currently a therapeutic option recognized by guidelines for the treatment of uncontrolled form of the disease.

The correct definition of the target patient, the type of biological drug to be used and the timing of intervention are crucial to guarantee a personalized therapy and optimize the cost/effectiveness of the treatment.

A panel of Italian pneumologists, allergologists, immunologists and ear, nose and throat specialists discussed in a series of virtual expert meetings the main criteria for patient characterization and therapeutic decision, highlighting multidisciplinarity, the constant dialogue between doctor and patient, the organization in networks and the use of registries as strategies to implement the management of CRSwNP patients, to reach the personalization of the treatment and the best use of the biological drug(s).

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References

Bachert C, Marple B, Schlosser RJ, et al. Adult chronic rhinosinusitis. Nat Rev Dis Primers. 2020;6(1):86. https://doi.org/10.1038/s41572-020-00218-1 PMID:33122665

Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(suppl S29):1-464. https://doi.org/10.4193/Rhin20.401PMID:32077450

De Corso E, Bilò MB, Matucci A, et al. Personalized Management of Patients with Chronic Rhinosinusitis with Nasal Polyps in Clinical Practice: A Multidisciplinary Consensus Statement. J Pers Med. 2022;12(5):846. https://doi.org/10.3390/jpm12050846 PMID:35629268

Bachert C, Bhattacharyya N, Desrosiers M, Khan AH. Burden of Disease in Chronic Rhinosinusitis with Nasal Polyps. J Asthma Allergy. 2021;14:127-134. https://doi.org/10.2147/JAA.S290424 PMID:33603409

Dietz de Loos DA, Hopkins C, Fokkens WJ. Symptoms in chronic rhinosinusitis with and without nasal polyps. Laryngoscope. 2013;123(1):57-63. https://doi.org/10.1002/lary.23671PMID:23280941

Bachert C, Gevaert P, Hellings P. Biotherapeutics in Chronic Rhinosinusitis with and without Nasal Polyps. J Allergy Clin Immunol Pract. 2017;5(6):1512-1516. https://doi.org/10.1016/j.jaip.2017.04.024 PMID:28526278

Mullol J, Azar A, Buchheit KM, Hopkins C, Bernstein JA. Chronic Rhinosinusitis With Nasal Polyps: Quality of Life in the Biologics Era. J Allergy Clin Immunol Pract. 2022;10(6):1434-1453.e9. https://doi.org/10.1016/j.jaip.2022.03.002 PMID:35306180

European Medicines Agency. Dupixent (Dupilumab). Summary of Product Characteristic 2021 Online: https://www.ema.europa.eu/en/documents/product-information/dupixent-epar-product-information_en.pdf.

European Medicines Agency. Xolair (Omalizumab). Summary of Product Characteristic 2020 Online: https://www.ema.europa.eu/en/documents/product-information/xolair-epar-product-information_en.pdf.

Fokkens WJ, Lund V, Bachert C, et al. EUFOREA consensus on biologics for CRSwNP with or without asthma. Allergy. 2019;74(12):2312-2319. https://doi.org/10.1111/all.13875PMID:31090937

Kuruvilla ME, Lee FE, Lee GB. Understanding Asthma Phenotypes, Endotypes, and Mechanisms of Disease. Clin Rev Allergy Immunol. 2019;56(2):219-233. https://doi.org/10.1007/s12016-018-8712-1 PMID:30206782

Pavlidis S, Takahashi K, Ng Kee Kwong F, et al; on behalf of the U-BIOPRED Study Group. “T2-high” in severe asthma related to blood eosinophil, exhaled nitric oxide and serum periostin. Eur Respir J. 2019;53(1):1800938. https://doi.org/10.1183/13993003.00938-2018PMID:30578390

Paoletti G, Malvezzi L, Riccio AM, et al. Nasal cytology as a reliable non-invasive procedure to phenotype patients with type 2 chronic rhinosinusitis with nasal polyps. World Allergy Organ J. 2022;15(11):100700. https://doi.org/10.1016/j.waojou.2022.100700 PMID:36321070

Workman AD, Kohanski MA, Cohen NA. Biomarkers in Chronic Rhinosinusitis with Nasal Polyps. Immunol Allergy Clin North Am. 2018;38(4):679-692. https://doi.org/10.1016/j.iac.2018.06.006 PMID:30342588

Danielides G, Lygeros S, Kanakis M, Naxakis S. Periostin as a biomarker in chronic rhinosinusitis: A contemporary systematic review. Int Forum Allergy Rhinol. 2022;12(12):1535-1550. https://doi.org/10.1002/alr.23018 PMID:35514144

Gevaert P, Calus L, Van Zele T, et al. Omalizumab is effective in allergic and nonallergic patients with nasal polyps and asthma. J Allergy Clin Immunol. 2013;131(1):110-6.e1. https://doi.org/10.1016/j.jaci.2012.07.047 PMID:23021878

Calabrese C, Seccia V, Pelaia C, et al. S. aureus and IgE-mediated diseases: pilot or copilot? A narrative review. Expert Rev Clin Immunol. 2022;18(6):639-647. https://doi.org/10.1080/1744666X.2022.2074402 PMID:35507006

Damask C, Chen M, Holweg CTJ, Yoo B, Millette LA, Franzese C. Defining the Efficacy of Omalizumab in Nasal Polyposis: A POLYP 1 and POLYP 2 Subgroup Analysis. Am J Rhinol Allergy. 2022;36(1):135-141. https://doi.org/10.1177/19458924211030486 PMID:34382434

Zheng M, Sima Y, Liu C, et al. Clinical effectiveness and potential predictability of omalizumab in patients with difficult-to-treat chronic rhinosinusitis with nasal polyps and asthma based on the noninvasive markers - A real-life prospective study. World Allergy Organ J. 2022;15(10):100702. https://doi.org/10.1016/j.waojou.2022.100702 PMID:36254182

Morandini P, Laino ME, Paoletti G, et al. Artificial intelligence processing electronic health records to identify commonalities and comorbidities cluster at Immuno Center Humanitas. Clin Transl Allergy. 2022;12(6):e12144. https://doi.org/10.1002/clt2.12144 PMID:35702725

European Medicines Agency. Nucala (Mepolizumab). Summary of Product Characteristic 2022 Online: https://www.ema.europa.eu/en/documents/product-information/nucala-epar-product-information_en.pdf.

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Published

2023-03-13

How to Cite

Menzella, F., Bagnasco, D., Bilò, M. B., Caminati, M., Cavaliere, C., Contoli, M., De Massimi, A., Gallo, S., Matucci, A., Ottaviano, G., Rossi, O., Seccia, V., Emmi, M., & Canevari, F. R. (2023). Management of patients with chronic rhinosinusitis and nasal polyposis in Italy: expert opinion on the diagnostic-therapeutic approach. AboutOpen, 10(1), 43–49. https://doi.org/10.33393/ao.2023.2555

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Vol. 10 No. 1 (2023): January-December 2023

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Copyright (c) 2023 Francesco Menzella, Diego Bagnasco, Maria Beatrice Bilò, Marco Caminati, Carlo Cavaliere, Marco Contoli, Alessio De Massimi, Stefania Gallo, Andrea Matucci, Giancarlo Ottaviano, Oliviero Rossi, Veronica Seccia, Martino Emmi, Frank Rikki Canevari

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Authors contributing to AboutOpen agree to publish their articles under the Creative Commons NonCommercial 4.0 International License (CC BY-NC 4.0), which allows third parties to copy and redistribute the material providing appropriate credit and a link to the license but does not allow to use the material for commercial purposes and to use the material if it has been remixed, transformed or built upon. 

Received 2022-12-16
Accepted 2023-02-20
Published 2023-03-13

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