Open AccessChronic rhinosinusitis with nasal polyposis: the role of personalized and integrated medicine
Author(s) -
Giorgio Ciprandi,
Matteo Gelardi
Publication year - 2021
Publication title -
monaldi archives for chest disease. pulmonary series/monaldi archives for chest disease/monaldi archives for chest disease. cardiac series
Language(s) - English
Resource type - Journals
eISSN - 2465-101X
pISSN - 1122-0643
DOI - 10.4081/monaldi.2021.1769
Subject(s) - medicine , chronic rhinosinusitis , nasal polyps , precision medicine , asthma , personalized medicine , immunology , allergy , nasal administration , immunoglobulin e , intensive care medicine , bioinformatics , pathology , antibody , biology
Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a common disorder. From a clinical and immunopathological point of view, different phenotypes and endotypes have been identified. As asthma is frequent comorbidity, biological agents for treating CRSwNP associated with asthma may be an attractive strategy. Biological agents have several mechanisms, such as antagonizing IgE, interleukin (IL) 4, IL-5, and IL-13. However, a workup is mandatory, mainly concerning pheno-endotyping. In this regard, clinical cytological grading (CCG) has been proposed as a useful tool to manage patients with CRSwNP as it allows us to define clinical and immunopathological phenotypes able to identify the ideal candidate for biologics. In particular, the mixed cellular pattern, such as eosinophils and mast cells, could be sensitive to anti-IL-4 agents. There is still a need for well-established indications, criteria of responsiveness, duration, and safety. Moreover, personalized medicine could be opportunely integrated and/or alternated with intranasal corticosteroids to prevent relevant adverse events.