A Case in which Good Control Was Obtained by Switching Biologics in Aspirin-exacerbated Respiratory Disease as a Comorbidity with Eosinophilic Chronic Rhinosinusitis

2020 ◽  
Vol 59 (2) ◽  
pp. 139-145
Author(s):  
Kosuke Akiyama ◽  
Hiroyuki Nakamura ◽  
Yasushi Samukawa ◽  
Hiroshi Hoshikawa
Keyword(s):  
Chronic Rhinosinusitis ◽  
Respiratory Disease ◽  
Good Control ◽  
Aspirin Exacerbated Respiratory Disease ◽  
Eosinophilic Chronic Rhinosinusitis

Dupilumab as Add-on Therapy for Chronic Rhinosinusitis With Nasal Polyposis in Aspirin Exacerbated Respiratory Disease

2020 ◽  
pp. 194589242096196
Author(s):  
S. Shahzad Mustafa ◽  
Karthik Vadamalai ◽  
Bryan Scott ◽  
Allison Ramsey
Keyword(s):  
Quality Of Life ◽  
Chronic Rhinosinusitis ◽  
Respiratory Disease ◽  
Nasal Polyposis ◽  
Total Serum ◽  
Life Questionnaire ◽  
Median Baseline ◽  
Aspirin Exacerbated Respiratory Disease ◽  
Snot 22

Background Aspirin-exacerbated respiratory disease (AERD) affects 7% of asthmatics. Usual therapies are inadequate for asthma and/or nasal polyposis, leading to decreased quality of life. Objective Our objective was to evaluate the efficacy of dupilumab in AERD patients with uncontrolled, chronic rhinosinusitis with nasal polyposis (CRSwNP). Methods Patients 18 years and older with a physician diagnosis of AERD and sino-nasal outcome test 22 (SNOT 22) score ≥19 despite standard medical therapy were eligible for the study. Patients received one month of placebo dosing, followed by 6 months of dupilumab. Patients were blinded to the order of therapy. Wilcoxon-paired rank sum test was used to compare study outcomes at baseline and the completion of the study. Results Ten patients completed the study. The median baseline SNOT 22 score improved from 46 [IQR: 34 to 64.8] to 9.5 [IQR: 2.5 to 19] after 6 months of therapy (p = 0.0050). The median baseline Lund MacKay score improved from 21.5 [IQR: 17 to 23.3] to 4 [IQR: 1.2 to 6] after 6 months of therapy (p = 0.0050). There was also improvement in the following secondary outcomes: asthma control test (ACT), mini asthma quality of life questionnaire (AQLQ), and University of Pennsylvania Smell Identification test (UPSIT). Exhaled nitric oxide (FeNO), total serum IgE, 24-hour urinary leukotriene E4, and serum thymus and activation regulated cytokine (TARC) also decreased. There were no significant study-related adverse events. Conclusion Dupilumab was highly effective as add-on therapy for CRSwNP in AERD, improving patient-reported outcomes, sinus opacification, and markers of T2 inflammation.

scholarly journals Aspirin Sensitivity and Chronic Rhinosinusitis with Polyps: A Fatal Combination

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Hendrik Graefe ◽  
Christina Roebke ◽  
Dirk Schäfer ◽  
Jens Eduard Meyer
Keyword(s):  
Chronic Rhinosinusitis ◽  
Respiratory Disease ◽  
Clinical Features ◽  
Nasal Polyposis ◽  
Molecular Mechanisms ◽  
Molecular Pathogenesis ◽  
Surgical Interventions ◽  
Aspirin Sensitivity ◽  
Aspirin Exacerbated Respiratory Disease ◽  
Lower Airways

Aspirin-exacerbated respiratory disease (AERD) refers to aspirin sensitivity, chronic rhinosinusitis (CRS), nasal polyposis, asthma, eosinophil inflammation in the upper and lower airways, urticaria, angioedema, and anaphylaxis following the ingestion of NSAIDs. Epidemiologic and pathophysiological links between these diseases are established. The precise pathogenesis remains less defined, even though there is some progress in the understanding of several molecular mechanisms. Nevertheless, these combinations of diseases in patients classified by AERD constitute a fatal combination and may be difficult to treat with standard medical and surgical interventions. This paper reviews in brief the epidemiology, clinical features, diagnosis, molecular pathogenesis, and specific therapies of patients classified by AERD and postulates future attempts to gain new insights into this disease.

Oral Corticosteroid Prescribing Habits for Rhinosinusitis: The American Rhinologic Society Membership

2017 ◽  
Vol 31 (1) ◽  
pp. 22-26 ◽  
Author(s):  
John R. Scott ◽  
Hannah M. J. Ernst ◽  
Brian W. Rotenberg ◽  
Luke Rudmik ◽  
Leigh J. Sowerby
Keyword(s):  
Chronic Rhinosinusitis ◽  
Respiratory Disease ◽  
Average Duration ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Prescribing Habits ◽  
Not Otherwise Specified ◽  
Aspirin Exacerbated Respiratory Disease ◽  
Starting Dose ◽  
Acute Bacterial Rhinosinusitis

Background In the field of otolaryngology, oral corticosteroids (OCS) are widely prescribed for rhinosinusitis. Although there is evidence in the literature regarding specific OCS dosing protocols, it is not known to what extent these recommendations are being followed. Objective To examine the current state of OCS prescribing habits for rhinosinusitis by American Rhinologic Society members. Methods An anonymous online survey was sent to all American Rhinologic Society members. Dosing, frequency, tapering, and overall prescribing habits for OCS were assessed in chronic rhinosinusitis with polyposis (CRSwP) and in chronic rhinosinusitis without polyposis and acute bacterial rhinosinusitis. The CRSwP group was subdivided into aspirin-exacerbated respiratory disease, allergic fungal sinusitis, and not otherwise specified. Results were compared with current guidelines. Descriptive statistics were used to analyze data. Results Ninety-three surveys were completed (response rate, 12.9%). Prednisone was the most common OCS prescribed. In the CRSwP-aspirin-exacerbated respiratory disease group (n = 86), the median starting dose was 60 mg (range, 4-80 mg) and the average duration was 8 days (range, 2-28 days). In the CRSwP-allergic fungal sinusitis group (n = 81), the median starting dose was 50 mg (range, 20-60 mg), and the average duration was 6 days (range, 2-35 days). In the CRSwP-not otherwise specified group (n = 84), the median starting dose was 50 mg (range, 20-80 mg) and the average duration was 5 days (range, 1-21 days). OCS were prescribed for chronic rhinosinusitis without polyposis and acute bacterial rhinosinusitis by 66.0 and 62.4% of respondents, respectively. Conclusion Significant heterogeneity existed in OCS prescribing habits for rhinosinusitis. Discrepancies were observed between survey results and evidence-based recommendations. Developing standardized OCS treatment protocols for rhinosinusitis may improve the quality of care by optimizing clinical outcomes and reducing the risk of complications.

scholarly journals Cytokines in Chronic Rhinosinusitis. Role in Eosinophilia and Aspirin-exacerbated Respiratory Disease

2015 ◽  
Vol 192 (6) ◽  
pp. 682-694 ◽  
Author(s):  
Whitney W. Stevens ◽  
Christopher J. Ocampo ◽  
Sergejs Berdnikovs ◽  
Masafumi Sakashita ◽  
Mahboobeh Mahdavinia ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Respiratory Disease ◽  
Aspirin Exacerbated Respiratory Disease
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