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About Type 2 Inflammation – Nasal Polyps

Type 2 Inflammation in Chronic Rhinosinusitis with Nasal Polypolis (CRSwNP)

CRSwNP is a Chronic Type 2 Inflammatory disease with high symptom burden and substantial unmet need

CRSwNP patients experience high symptom burden and have a reduced health-related QoL²

Nasal Symptoms

  • Congestion
  • Sneezing
  • Loss of smell/taste
  • Runny nose
  • Nasal discharge

Ear and Facial Symptoms

  • Facial pain
  • Facial pressure
  • Ear pain
  • Ear pressure
  • Dizziness

Health-Related QoL Impact

  • Difficulty falling/staying asleep
  • Fatigue
  • Waking up tired
  • Reduced concentration
  • Reduced productivity

Psychological Symptoms

  • Frustration, restlessness, irritability
  • Sadness
  • Embarrassment

Reference

  1. Abdalla S, Alreefy H, Hopkins C. Prevalence of sinonasal outcome test (SNOT-22) symptoms in patients undergoing surgery for chronic rhinosinusitis in the England and Wales National prospective audit. Clin Otolaryngol. 2012;37(4):276-282.

CRSwNP patients often have coexisting Type 2 Inflammatory disease1,2

  • 50% Asthma   
  • 75% Allergic Rhinitis
  • 10-20% NSAID-ERD

Abbreviations

NSAID-ERD, nonsteroidal anti-inflammatory drug–exacerbated respiratory disease; QoL, quality of life.

References

  1. Khan A, Vandeplas G, Huynh TMT, et al. The Global Allergy and Asthma European Network (GALEN rhinosinusitis cohort: a large European cross-sectional study of chronic rhinosinusitis patients with and without nasal polyps. Rhinology. 2019;57(1):32-42.
  2. White AA, Stevenson DD. Aspirin-exacerbated respiratory disease. N Engl J Med. 2018;379(11):1060-1070.

Conventional therapy, including steroid bursts and surgery, does not always provide long-term relief

  • Treatment guidelines recommend cautious use of systemic steroids ⁵⁻⁹
  • Systemic steroids are not recommended as chronic therapy because of the risk of serious adverse effects with long-term use
  • Difficult-to-treat patients are often refractory to medical and surgical management ¹⁰ 35% of patients experience polyp recurrence within 6 months of surgery

80% of patients with CRSwNP have type 2 inflammation, which contributed to symptoms and polyp formation7,a ᵃIn Western countries

References

  1. Slavin RG, Spector SL, Bernstein IL. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol. 2005;116(6 suppl):S13-S47.
  2. Fokkens WJ, Lund VJ, Mullol J, et al. European position paper on rhinosinusitis and nasal polyps 2012. Rhinology. 2012;50(23):1-298.
  3. Orlandi RR, Kingdom TT, Hwang PH, et al. International consensus statement on allergy and rhinology: rhinosinusitis. Int Forum Allergy Rhinol. 2016;6(suppl 1):S22-S209.
  4. Kaplan A. Canadian guidelines for chronic rhinosinusitis: clinical summary. Can Fam Physician. 2013;59(12):e528-e534.
  5. Alobid I, Antón E, Armengot M, et al. SEAIC-SEORL. Consensus Document on Nasal Polyposis. POLINA Project. J Investig Allergol Clin Immunol. 2011;21(suppl 1):1-58.
  6. DeConde AS, Mace JC, Levy JM, Rudmik L, Alt JA, Smith TL. Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. Laryngoscope. 2017;127(3):550-555.
  7. Chaaban MR, Walsh EM, Woodworth BA. Epidemiology and differential diagnosis of nasal polyps. Am J Rhinol Allergy. 2013;27(6):473-478.

IL-4 and IL-13 are Key and Central Drivers of Type 2 Inflammation

IL-4 and IL-13 are central type 2 cytokines that have shared and distinct roles in the pathophysiology of CRSwNP1,2

Abbreviation

ILC2, Type 2 Innate lymphoid cells

References

  1. Gandhi NA, Bennett BL, Graham NMH, Pirozzi G, Stahl N, Yancopoulos GD. Targeting key proximal drivers of type 2 inflammation in disease. Nat Rev Drug Discov. 2016;15(1):35-50.
  2. Schleimer RP. Immunopathogenesis of chronic rhinosinusitis and nasal polyposis. Annu Rev Pathol. 2017;12:331-357.
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