Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Clinical and Translational Allergy
Published in: Clinical and Translational Allergy 1/2018

Open Access 01-12-2018 | Research

Sinus computed tomography predicts clinical response to corticosteroids in chronic rhinosinusitis with nasal polyps

Authors: Haiyu Hong, Dan Wang, Kai Sen Tan, Rui Zheng, Fenghong Chen, Wenxiang Gao, Haixin He, Jianbo Shi, Yunping Fan, Qintai Yang, Yueqi Sun

Published in: Clinical and Translational Allergy | Issue 1/2018

Login to get access

Abstract

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease usually characterized by chronic eosinophilia in the sinonasal mucosa, which often requires glucocorticoid (GC) therapy. However, the therapeutic response varies markedly between individuals. The objective of this study was to evaluate the diagnostic values of sinus computed tomography (CT) for GC-sensitivity in patients with CRSwNP.

Methods

We conducted a prospective, single-blinded study of 47 consecutive patients with CRSwNP. These patients were given a course of oral prednisone (30 mg daily for 14 days) and subsequently classified into objectively GC-sensitive and -insensitive subgroup according to the change in nasal polyp size score, or subjectively GC-sensitive and -insensitive subgroup according to the change in total nasal symptom score. The following parameters were compared between GC-sensitive and GC-insensitive subgroups: Lund-Mackay scores, olfactory cleft (OC) scores, and blood eosinophil counts and ratio (percentage of the total white blood cells).

Results

25/47 (53.2%) and 29/47 (61.7%) patients were objectively and subjectively sensitive to GC therapy, respectively. The OC score and the blood eosinophil counts and ratio in GC-sensitive subgroup were significantly higher than those in GC-insensitive subgroup, defined either objectively or subjectively. Multivariate logistic regression revealed that OC score was independent risk factor for objective or subjective GC-sensitivity. The OC score exhibited comparable accuracy with the blood eosinophil ratio as predictor of objective and subjective GC-sensitivity (the OC score AUC = 0.775 and 0.829, respectively). A OC score of 3.5 could act as a reliable indicator for predicting the clinical response to GC therapy in CRSwNP.

Conclusion

Our prospective findings validate the potential value of sinus CT scan in predicting GC-sensitivity in CRSwNP patients.
Appendix
Available only for authorised users
Literature
1.
Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, Cohen N, Cervin A, Douglas R, Gevaert P, et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology. 2012;50(1):1–12.PubMedCrossRef
2.
Shi JB, Fu QL, Zhang H, Cheng L, Wang YJ, Zhu DD, Lv W, Liu SX, Li PZ, Ou CQ, et al. Epidemiology of chronic rhinosinusitis: results from a cross-sectional survey in seven Chinese cities. Allergy. 2015;70(5):533–9.CrossRefPubMedPubMedCentral
3.
Wang X, Zhang N, Bo M, Holtappels G, Zheng M, Lou H, Wang H, Zhang L, Bachert C. Diversity of TH cytokine profiles in patients with chronic rhinosinusitis: a multicenter study in Europe, Asia, and Oceania. J Allergy Clin Immunol. 2016;138(5):1344–53.CrossRefPubMed
4.
Bachert C, Gevaert P, Holtappels G, Johansson SG, van Cauwenberge P. Total and specific IgE in nasal polyps is related to local eosinophilic inflammation. J Allergy Clin Immunol. 2001;107(4):607–14.CrossRefPubMed
5.
Newman LJ, Platts-Mills TA, Phillips CD, Hazen KC, Gross CW. Chronic sinusitis. Relationship of computed tomographic findings to allergy, asthma, and eosinophilia. JAMA. 1994;271(5):363–7.CrossRefPubMed
6.
Wen W, Liu W, Zhang L, Bai J, Fan Y, Xia W, Luo Q, Zheng J, Wang H, Li Z, et al. Increased neutrophilia in nasal polyps reduces the response to oral corticosteroid therapy. J Allergy Clin Immunol. 2012;129(6):1522–8.CrossRefPubMed
7.
Cao PP, Li HB, Wang BF, Wang SB, You XJ, Cui YH, Wang DY, Desrosiers M, Liu Z. Distinct immunopathologic characteristics of various types of chronic rhinosinusitis in adult Chinese. J Allergy Clin Immunol. 2009;124(3):478–84.CrossRefPubMed
8.
Ito K, Chung KF, Adcock IM. Update on glucocorticoid action and resistance. J Allergy Clin Immunol. 2006;117(3):522–43.CrossRefPubMed
9.
Meng Y, Lou H, Wang C, Zhang L. Predictive significance of computed tomography in eosinophilic chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol. 2016;6(8):812–9.CrossRefPubMed
10.
11.
Milara J, Morell A, Ballester B, Armengot M, Morcillo E, Cortijo J. MUC4 impairs the anti-inflammatory effects of corticosteroids in patients with chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol. 2017;139(3):855–62.CrossRefPubMed
12.
Milara J, Peiro T, Armengot M, Frias S, Morell A, Serrano A, Cortijo J. Mucin 1 downregulation associates with corticosteroid resistance in chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol. 2015;135(2):470–6.CrossRefPubMed
13.
Lund VJ, Kennedy DW. Staging for rhinosinusitis. Otolaryngol Head Neck Surg. 1997;117(3 Pt 2):S35–40.CrossRefPubMed
14.
Chen F, Luo X, Xu R, Deng J, Zuo K, Li H, Shi J. Evaluation of airway hyperresponsiveness in chronic rhinosinusitis: values of sinus computed tomography. Ann Allergy Asthma Immunol. 2014;113(6):609–13.CrossRefPubMed
15.
Hellings PW, Fokkens WJ, Akdis C, Bachert C, Cingi C, Dietz DLD, Gevaert P, Hox V, Kalogjera L, Lund V, et al. Uncontrolled allergic rhinitis and chronic rhinosinusitis: where do we stand today? Allergy. 2013;68(1):1–7.CrossRefPubMed
16.
Won TB, Jang E, Min SK, Kim SW. Treatment outcomes and predictors for systemic steroids in nasal polyposis. Acta Otolaryngol. 2012;132(Suppl 1):S82–7.CrossRefPubMed
17.
Wang M, Shi P, Chen B, Shi G, Li H, Wang H. Superantigen-induced glucocorticoid insensitivity in the recurrence of chronic rhinosinusitis with nasal polyps. Otolaryngol Head Neck Surg. 2011;145(5):717–22.CrossRefPubMed
18.
Choi BR, Kwon JH, Gong SJ, Kwon MS, Cho JH, Kim JH, Oh S, Roh HJ, Kim DE. Expression of glucocorticoid receptor mRNAs in glucocorticoid-resistant nasal polyps. Exp Mol Med. 2006;38(5):466–73.CrossRefPubMed
19.
Valera FC, Queiroz R, Scrideli C, Tone LG, Anselmo-Lima WT. Evaluating budesonide efficacy in nasal polyposis and predicting the resistance to treatment. Clin Exp Allergy. 2009;39(1):81–8.CrossRefPubMed
20.
Aversa S, Ondolo C, Abbadessa G, Piccione F, Carriero V, Fulcheri A, Lauria A, De Francia S, Racca S. Steroid resistance in nasal polyposis: role of glucocorticoid receptor and TGF-beta1. Rhinology. 2012;50(4):427–35.PubMed
21.
Iskander NM, El-Hennawi DM, Yousef TF, El-Tabbakh MT, Elnahriry TA. Evaluation of the effect of cigarette smoking on the olfactory neuroepithelium of New Zealand white rabbit, using scanning electron microscope. Eur Arch Otorhinolaryngol. 2017;274(6):2461–8.CrossRefPubMed
22.
Deykin A, Lazarus SC, Fahy JV, Wechsler ME, Boushey HA, Chinchilli VM, Craig TJ, Dimango E, Kraft M, Leone F, et al. Sputum eosinophil counts predict asthma control after discontinuation of inhaled corticosteroids. J Allergy Clin Immunol. 2005;115(4):720–7.CrossRefPubMed
23.
Brightling CE, Green RH, Pavord ID. Biomarkers predicting response to corticosteroid therapy in asthma. Treat Respir Med. 2005;4(5):309–16.CrossRefPubMed
24.
Hu Y, Cao PP, Liang GT, Cui YH, Liu Z. Diagnostic significance of blood eosinophil count in eosinophilic chronic rhinosinusitis with nasal polyps in Chinese adults. Laryngoscope. 2012;122(3):498–503.CrossRefPubMed
25.
Thompson CF, Price CP, Huang JH, Min JY, Suh LA, Shintani-Smith S, Conley DB, Schleimer RP, Kern RC, Tan BK. A pilot study of symptom profiles from a polyp vs an eosinophilic-based classification of chronic rhinosinusitis. Int Forum Allergy Rhinol. 2016;6(5):500–7.CrossRefPubMed
26.
Racette SD, Wijewickrama RC, Jayaprakash V, Sherris DA, Santos C, Kita H, O’Donnell FJ, Ponikau JU. Correlation of Symptoms, Clinical Signs, and Biomarkers of Inflammation in Postsurgical Chronic Rhinosinusitis. Ann Otol Rhinol Laryngol. 2017;126(6):455–62.CrossRefPubMed
Metadata
Title
Sinus computed tomography predicts clinical response to corticosteroids in chronic rhinosinusitis with nasal polyps
Authors
Haiyu Hong
Dan Wang
Kai Sen Tan
Rui Zheng
Fenghong Chen
Wenxiang Gao
Haixin He
Jianbo Shi
Yunping Fan
Qintai Yang
Yueqi Sun
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Clinical and Translational Allergy / Issue 1/2018
Electronic ISSN: 2045-7022
DOI
https://doi.org/10.1186/s13601-018-0211-1

Other articles of this Issue 1/2018

Clinical and Translational Allergy 1/2018 Go to the issue

Research

Tonsillar cytokine expression between patients with tonsillar hypertrophy and recurrent tonsillitis

Research

Deep analysis of immune response and metabolic signature in children with food protein induced enterocolitis to cow’s milk

Brief communication

Pollen and spore monitoring in the world

Research

Assessing severity of anaphylaxis: a data-driven comparison of 23 instruments

Letter to the Editor

Improvement in diagnostic delays over time in patients with hereditary angioedema: findings from the Icatibant Outcome Survey

Review

Promoting and achieving excellence in the delivery of Integrated Allergy Care: the European Academy of Allergy & Clinical Immunology competencies for allied health professionals working in allergy