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

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
European Archives of Oto-Rhino-Laryngology
Published in: European Archives of Oto-Rhino-Laryngology 12/2023

13-07-2023 | Rhinosinusitis | Rhinology

Comprehensive evaluation of type 2 endotype and clinical features in patients with chronic rhinosinusitis with nasal polyps in Taiwan: a cross-sectional study

Authors: Yi-Tsen Lin, Chih-Feng Lin, Chun-Kang Liao, Te-Huei Yeh

Published in: European Archives of Oto-Rhino-Laryngology | Issue 12/2023

Login to get access

Abstract

Purpose

Endotype-driven treatment has been introduced in the management of chronic rhinosinusitis with nasal polyps (CRSwNP), and an understanding of the associations between phenotypes and endotypes of CRSwNP will be beneficial in identifying responders. We aimed to determine the correlations between clinical manifestations and type 2 inflammatory mediators of sinonasal tissues.

Methods

Adult patients undergoing endoscopic sinus surgery for bilateral CRSwNP were prospectively enrolled. Tissue eosinophilia and type 2 mediator expression in tissue homogenates were assessed and correlated with clinical features, including symptoms, comorbidities, blood eosinophil counts, specific allergen immunoglobulin (IgE) testing, computed tomography (CT) scan findings, and Sino-Nasal Outcome Test-22 scores.

Results

A total of 93 subjects were recruited in our study. Fifty-nine (63.4%) cases were identified as the eosinophilic endotype, demonstrating with higher rates of comorbidity of asthma, blood eosinophilia and a high ethmoid-maxillary ratio on CT images. To correlate of phenotypes with the inflammatory mediator profile, multivariate analyses revealed the associations of IgE expression in nasal polyp tissues with allergen sensitization (p = 0.042), CT ethmoid-maxillary ratio (p = 0.001) and tissue eosinophil counts (p = 0.022); the association of interleukin (IL-5) expression with the blood eosinophil percentage (p = 0.020); and the association of IL-13 expression with white blood cell count (p = 0.002) and central compartment-type inflammation (p < 0.001).

Conclusion

We demonstrated associations of IgE and IL-5 expression with clinical features of eosinophilic-type inflammation and a significantly elevated level of IL-13 in patients with central-compartment-type CRSwNP. These observations may be useful when considering the use of type 2 biologic treatment and require further validation studies.
Appendix
Available only for authorised users
Literature
1.
Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, Toppila-Salmi S, Bernal-Sprekelsen M, Mullol J (2020) Executive summary of EPOS 2020 including integrated care pathways. Rhinology 58(2):82–111PubMedCrossRef
2.
Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK et al (2021) International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 11(3):213–739PubMedCrossRef
3.
Bachert C, Han JK, Desrosiers M, Hellings PW, Amin N, Lee SE, Mullol J, Greos LS, Bosso JV, Laidlaw TM et al (2019) Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials. Lancet 394(10209):1638–1650PubMedCrossRef
4.
Gevaert P, Omachi TA, Corren J, Mullol J, Han J, Lee SE, Kaufman D, Ligueros-Saylan M, Howard M, Zhu R et al (2020) Efficacy and safety of omalizumab in nasal polyposis: 2 randomized phase 3 trials. J Allergy Clin Immunol 146(3):595–605PubMedCrossRef
5.
Han JK, Bachert C, Fokkens W, Desrosiers M, Wagenmann M, Lee SE, Smith SG, Martin N, Mayer B, Yancey SW et al (2021) Mepolizumab for chronic rhinosinusitis with nasal polyps (SYNAPSE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Respir Med 9(10):1141–1153PubMedCrossRef
6.
Fokkens WJ, Lund V, Bachert C, Mullol J, Bjermer L, Bousquet J, Canonica GW, Deneyer L, Desrosiers M, Diamant Z et al (2019) EUFOREA consensus on biologics for CRSwNP with or without asthma. Allergy 74(12):2312–2319PubMedCrossRef
7.
Fujieda S, Imoto Y, Kato Y, Ninomiya T, Tokunaga T, Tsutsumiuchi T, Yoshida K, Kidoguchi M, Takabayashi T (2019) Eosinophilic chronic rhinosinusitis. Allergol Int 68(4):403–412PubMedCrossRef
8.
Zhang Y, Gevaert E, Lou H, Wang X, Zhang L, Bachert C, Zhang N (2017) Chronic rhinosinusitis in Asia. J Allergy Clin Immunol 140(5):1230–1239PubMedCrossRef
9.
Zuo K, Guo J, Chen F, Xu R, Xu G, Shi J, Li H (2014) Clinical characteristics and surrogate markers of eosinophilic chronic rhinosinusitis in Southern China. Eur Arch Otorhinolaryngol 271(9):2461–2468PubMedCrossRef
10.
Ho J, Hamizan AW, Alvarado R, Rimmer J, Sewell WA, Harvey RJ (2018) Systemic predictors of eosinophilic chronic rhinosinusitis. Am J Rhinol Allergy 32(4):252–257PubMedCrossRef
11.
Tokunaga T, Sakashita M, Haruna T, Asaka D, Takeno S, Ikeda H, Nakayama T, Seki N, Ito S, Murata J et al (2015) Novel scoring system and algorithm for classifying chronic rhinosinusitis: the JESREC study. Allergy 70(8):995–1003PubMedCrossRef
12.
Steelant B, Seys SF, Van Gerven L, Van Woensel M, Farre R, Wawrzyniak P, Kortekaas Krohn I, Bullens DM, Talavera K, Raap U et al (2018) Histamine and T helper cytokine-driven epithelial barrier dysfunction in allergic rhinitis. J Allergy Clin Immunol 141(3):951-963 e958PubMedCrossRef
13.
Schleimer RP (2017) Immunopathogenesis of chronic rhinosinusitis and nasal polyposis. Annu Rev Pathol 12:331–357PubMedCrossRef
14.
Tomassen P, Vandeplas G, Van Zele T, Cardell LO, Arebro J, Olze H, Forster-Ruhrmann U, Kowalski ML, Olszewska-Ziaber A, Holtappels G et al (2016) Inflammatory endotypes of chronic rhinosinusitis based on cluster analysis of biomarkers. J Allergy Clin Immunol 137(5):1449-1456 e1444PubMedCrossRef
15.
Stevens WW, Peters AT, Tan BK, Klingler AI, Poposki JA, Hulse KE, Grammer LC, Welch KC, Smith SS, Conley DB et al (2019) Associations between inflammatory endotypes and clinical presentations in chronic rhinosinusitis. J Allergy Clin Immunol Pract 7(8):2812-2820 e2813PubMedPubMedCentralCrossRef
16.
Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, Cohen N, Cervin A, Douglas R, Gevaert P et al (2012) EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology 50(1):1–12PubMedCrossRef
17.
18.
Yeh TH, Tsai CH, Chen YS, Hsu WC, Cheng CH, Hsu CJ, Lee SY (2007) Increased communication among nasal epithelial cells in air-liquid interface culture. Laryngoscope 117(8):1439–1444PubMedCrossRef
19.
Paris G, Pozharskaya T, Asempa T, Lane AP (2014) Damage-associated molecular patterns stimulate interleukin-33 expression in nasal polyp epithelial cells. Int Forum Allergy Rhinol 4(1):15–21PubMedPubMedCentralCrossRef
20.
Yang SH, Kao TI, Chiang BL, Chen HY, Chen KH, Chen JL (2015) Immune-modulatory effects of bu-zhong-yi-qi-tang in ovalbumin-induced murine model of allergic asthma. PLoS ONE 10(6):e0127636PubMedPubMedCentralCrossRef
21.
Ishitoya J, Sakuma Y, Tsukuda M (2010) Eosinophilic chronic rhinosinusitis in Japan. Allergol Int 59(3):239–245PubMedCrossRef
22.
Kim DK, Lim HS, Eun KM, Seo Y, Kim JK, Kim YS, Kim MK, Jin S, Han SC, Kim DW (2021) Subepithelial neutrophil infiltration as a predictor of the surgical outcome of chronic rhinosinusitis with nasal polyps. Rhinology 59(2):173–180PubMed
23.
Lou H, Meng Y, Piao Y, Zhang N, Bachert C, Wang C, Zhang L (2016) Cellular phenotyping of chronic rhinosinusitis with nasal polyps. Rhinology 54(2):150–159PubMedCrossRef
24.
Lin YT, Lin CF, Liao CK, Chiang BL, Yeh TH (2021) Clinical characteristics and cytokine profiles of central-compartment-type chronic rhinosinusitis. Int Forum Allergy Rhinol 11(7):1064–1073PubMedCrossRef
25.
Shih LC, Hsieh BH, Ma JH, Huang SS, Tsou YA, Lin CD, Huang KH, Tai CJ (2022) A comparison of central compartment atopic disease and lateral dominant nasal polyps. Int Forum Allergy Rhinol 12(11):1387–1396PubMedCrossRef
26.
Doroudchi A, Pathria M, Modena BD (2020) Asthma biologics: comparing trial designs, patient cohorts and study results. Ann Allergy Asthma Immunol 124(1):44–56PubMedCrossRef
27.
Zhang N, Van Zele T, Perez-Novo C, Van Bruaene N, Holtappels G, DeRuyck N, Van Cauwenberge P, Bachert C (2008) Different types of T-effector cells orchestrate mucosal inflammation in chronic sinus disease. J Allergy Clin Immunol 122(5):961–968PubMedCrossRef
28.
Wang X, Zhang N, Bo M, Holtappels G, Zheng M, Lou H, Wang H, Zhang L, Bachert C (2016) Diversity of TH cytokine profiles in patients with chronic rhinosinusitis: a multicenter study in Europe, Asia, and Oceania. J Allergy Clin Immunol 138(5):1344–1353PubMedCrossRef
29.
Cao PP, Li HB, Wang BF, Wang SB, You XJ, Cui YH, Wang DY, Desrosiers M, Liu Z (2009) Distinct immunopathologic characteristics of various types of chronic rhinosinusitis in adult Chinese. J Allergy Clin Immunol 124(3):478-484 e471-472PubMedCrossRef
30.
Shi LL, Song J, Xiong P, Cao PP, Liao B, Ma J, Zhang YN, Zeng M, Liu Y, Wang H et al (2014) Disease-specific T-helper cell polarizing function of lesional dendritic cells in different types of chronic rhinosinusitis with nasal polyps. Am J Respir Crit Care Med 190(6):628–638PubMedCrossRef
31.
Bachert C, Gevaert P, Holtappels G, Johansson SG, van Cauwenberge P (2001) Total and specific IgE in nasal polyps is related to local eosinophilic inflammation. J Allergy Clin Immunol 107(4):607–614PubMedCrossRef
32.
Bachert C, Humbert M, Hanania NA, Zhang N, Holgate S, Buhl R, Broker BM (2020) Staphylococcus aureus and its IgE-inducing enterotoxins in asthma: current knowledge. Eur Respir J 55(4):1901592PubMedCrossRef
33.
Bachert C, Maurer M, Palomares O, Busse WW (2021) What is the contribution of IgE to nasal polyposis? J Allergy Clin Immunol 147(6):1997–2008PubMedCrossRef
34.
Chen M, Choo E, Yoo B, Raut P, Haselkorn T, Pazwash H, Holweg CTJ, Hudes G (2021) No difference in omalizumab efficacy in patients with asthma by number of asthma-related and allergic comorbidities. Ann Allergy Asthma Immunol 126(6):666–673PubMedCrossRef
35.
Lemos-Rodriguez AM, Farzal Z, Sreenath SB, Thorp BD, Senior BA, Zanation AM, Ebert CS Jr (2017) The impact of total immunoglobulin E levels on outcomes of maximal medical therapy for chronic rhinosinusitis. Allergy Rhinol (Providence) 8(1):5–12PubMedCrossRef
36.
37.
Pavord ID, Korn S, Howarth P, Bleecker ER, Buhl R, Keene ON, Ortega H, Chanez P (2012) Mepolizumab for severe eosinophilic asthma (DREAM): a multicentre, double-blind, placebo-controlled trial. Lancet 380(9842):651–659PubMedCrossRef
38.
Matucci A, Maggi E, Vultaggio A (2019) Eosinophils, the IL-5/IL-5Ralpha axis, and the biologic effects of benralizumab in severe asthma. Respir Med 160:105819PubMedCrossRef
39.
Laviolette M, Gossage DL, Gauvreau G, Leigh R, Olivenstein R, Katial R, Busse WW, Wenzel S, Wu Y, Datta V et al (2013) Effects of benralizumab on airway eosinophils in asthmatic patients with sputum eosinophilia. J Allergy Clin Immunol 132(5):1086-1096 e1085PubMedPubMedCentralCrossRef
40.
Mullol J, Bachert C, Amin N, Desrosiers M, Hellings PW, Han JK, Jankowski R, Vodicka J, Gevaert P, Daizadeh N et al (2022) Olfactory outcomes with dupilumab in chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol Pract 10(4):1086-1095 e1085PubMedCrossRef
41.
Cao PP, Wang ZC, Schleimer RP, Liu Z (2019) Pathophysiologic mechanisms of chronic rhinosinusitis and their roles in emerging disease endotypes. Ann Allergy Asthma Immunol 122(1):33–40PubMedCrossRef
42.
Fujieda S, Matsune S, Takeno S, Ohta N, Asako M, Bachert C, Inoue T, Takahashi Y, Fujita H, Deniz Y et al (2022) Dupilumab efficacy in chronic rhinosinusitis with nasal polyps from SINUS-52 is unaffected by eosinophilic status. Allergy 77(1):186–196PubMedCrossRef
43.
Wang X, Zhang N, Bo M, Holtappels G, Zheng M, Lou H, Wang H, Zhang L, Bachert C (2016) Diversity of T(H) cytokine profiles in patients with chronic rhinosinusitis: A multicenter study in Europe, Asia, and Oceania. J Allergy Clin Immunol 138(5):1344–1353PubMedCrossRef
44.
Kim DK, Eun KM, Kim MK, Cho D, Han SA, Han SY, Seo Y, Lee DH, Cho SH, Kim DW (2019) Comparison between signature cytokines of nasal tissues in subtypes of chronic rhinosinusitis. Allergy Asthma Immunol Res 11(2):201–211PubMedCrossRef
Metadata
Title
Comprehensive evaluation of type 2 endotype and clinical features in patients with chronic rhinosinusitis with nasal polyps in Taiwan: a cross-sectional study
Authors
Yi-Tsen Lin
Chih-Feng Lin
Chun-Kang Liao
Te-Huei Yeh
Publication date
13-07-2023
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Oto-Rhino-Laryngology / Issue 12/2023
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-023-08118-2

Other articles of this Issue 12/2023

European Archives of Oto-Rhino-Laryngology 12/2023 Go to the issue

Head and Neck

Can functional septoturbinoplasty, with or without nasal valve suspension suture (FSTVS), alter the initial findings of drug-induced sleep endoscopy (DISE) in patients with obstructive sleep apnea syndrome (OSAS)?

Letter to the Editor

The mast cell: the comfortable third in recent CRS research

Rhinology

Intranasal trigeminal sensitivity to mechanical stimuli is associated with the perception of nasal patency

Head and Neck

Application of prolonged submental perforator flap to repair the postoperative defect of upper airway malignancy

How I do it

Combined laryngeal framework surgery and cricopharyngeal muscle-origin transection: a novel effective surgery for dysphagia with pharyngolaryngeal palsy and cricopharyngeal dysfunction under local anesthesia

Rhinology

Recreating the microscopic direct access Draf 2a frontal sinusotomy in the endoscopic era and comparison to an angled instrument approach