Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a predominantly type 2 inflammation-mediated disease of the nasal mucosa and paranasal sinuses that often coexists with asthma. The role of atopy in the development and severity of CRSwNP is still a controversial issue. Objective: The aim of our study was to propose a systematic allergy workup to identify atopic patients in the context of CRSwNP and to characterize their allergen sensitization profile (sources/molecules). Methods: Patients with a diagnosis of CRSwNP (n = 97) were studied in the otorhinolaryngologist and allergy settings. Demographic and clinical data were collected for each patient. Different allergen sensitization profiles (sources/molecules) were evaluated in atopic CRSwNP patients by using component-resolved diagnosis (CRD). Results: In our cohort of patients, the CRSwNP was frequently diagnosed during adulthood with significant impact on health-related quality of life. Asthma and atopy were the most common comorbidities with a prevalence of asthma in the atopic group. In CRSwNP patients sensitized to grass pollens and/or to house dust mites, the CRD analysis revealed a prevalence of sensitization to species-specific allergens of Phleum pratense (Phl p1, Phl p2, and Phl p5) or Dermatophagoides pteronyssinus (Der p1 and Der p2) rather than to cross-reactive ones. Conclusion: To define the allergen sensitization profile in atopic CRSwNP patients by CRD, it may be useful to better characterize type 2 inflammation, thus providing a personalized endotype-driven treatment.

Keywords:
Nasal polyps, Allergy, Component-resolved diagnosis
1.
Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European position paper on rhinosinusitis and nasal polyps 2020.
Rhinology
. 2020 Feb 20;58(Suppl S29):1–464.
2.
Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T, et al. A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force.
Allergy
. 2001 Sep;56(9):813–24. Erratum in: Allergy. 2001 Dec;56(12):1229.
3.
Wachholz PA, Dearman RJ, Kimber I. Detection of allergen-specific IgE antibody responses.
J Immunotoxicol
. 2005 Jul 1;1(3):189–99.
4.
Heinzerling L, Mari A, Bergmann KC, Bresciani M, Burbach G, Darsow U, et al. The skin prick test: European standards.
Clin Transl Allergy
. 2013 Feb 1;3(1):3.
5.
Ansotegui IJ, Melioli G, Canonica GW, Caraballo L, Villa E, Ebisawa M, et al. Erratum to “IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper” [World Allergy Organ J 13/2 (2020) 100080].
World Allergy Organ J
. 2021 Jun 17;14(7):100557. Erratum for: World Allergy Organ J. 2020 Feb 25;13(2):100080.
6.
Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, Hofmaier S, et al. EAACI molecular allergology user’s guide.
Pediatr Allergy Immunol
. 2016 May;27(Suppl 23):1–250.
7.
Muñoz del Castillo F, Jurado-Ramos A, Fernández-Conde BL, Soler R, Barasona MJ, Cantillo E, et al. Allergenic profile of nasal polyposis.
J Investig Allergol Clin Immunol
. 2009;19(2):110–6.
8.
Batra PS, Tong L, Citardi MJ. Analysis of comorbidities and objective parameters in refractory chronic rhinosinusitis.
Laryngoscope
. 2013 Dec;123 Suppl 7:S1–11.
9.
Tan BK, Zirkle W, Chandra RK, Lin D, Conley DB, Peters AT, et al. Atopic profile of patients failing medical therapy for chronic rhinosinusitis.
Int Forum Allergy Rhinol
. 2011 Mar–Apr;1(2):88–94.
10.
Pumhirun P, Limitlaohapanth C, Wasuwat P. Role of allergy in nasal polyps of Thai patients.
Asian Pac J Allergy Immunol
. 1999 Mar;17(1):13–5.
11.
Houser SM, Keen KJ. The role of allergy and smoking in chronic rhinosinusitis and polyposis.
Laryngoscope
. 2008 Sep;118(9):1521–7.
12.
Ramadan HH, Fornelli R, Ortiz AO, Rodman S. Correlation of allergy and severity of sinus disease.
Am J Rhinol
. 1999 Sep–Oct;13(5):345–7.
13.
Ho J, Alvarado R, Rimmer J, Sewell WA, Harvey RJ. Atopy in chronic rhinosinusitis: impact on quality of life outcomes.
Int Forum Allergy Rhinol
. 2019 May;9(5):501–7.
14.
Görgülü O, Ozdemir S, Canbolat EP, Sayar C, Olgun MK, Akbaş Y. Analysis of the roles of smoking and allergy in nasal polyposis.
Ann Otol Rhinol Laryngol
. 2012 Sep;121(9):615–9.
15.
Erbek SS, Erbek S, Topal O, Cakmak O. The role of allergy in the severity of nasal polyposis.
Am J Rhinol
. 2007 Nov–Dec;21(6):686–90.
16.
Pearlman AN, Chandra RK, Chang D, Conley DB, Tripathi-Peters A, Grammer LC, et al. Relationships between severity of chronic rhinosinusitis and nasal polyposis, asthma, and atopy.
Am J Rhinol Allergy
. 2009 Mar–Apr;23(2):145–8.
17.
Robinson S, Douglas R, Wormald PJ. The relationship between atopy and chronic rhinosinusitis.
Am J Rhinol
. 2006 Nov–Dec;20(6):625–8.
18.
Abdullah B, Vengathajalam S, Md Daud MK, Wan Mohammad Z, Hamizan A, Husain S. The clinical and radiological characterizations of the allergic phenotype of chronic rhinosinusitis with nasal polyps.
J Asthma Allergy
. 2020 Oct 27;13:523–31.
19.
Marcus S, Schertzer J, Roland LT, Wise SK, Levy JM, DelGaudio JM. Central compartment atopic disease: prevalence of allergy and asthma compared with other subtypes of chronic rhinosinusitis with nasal polyps.
Int Forum Allergy Rhinol
. 2020 Feb;10(2):183–9.
20.
Philpott CM, Erskine S, Hopkins C, Kumar N, Anari S, Kara N, et al. Prevalence of asthma, aspirin sensitivity and allergy in chronic rhinosinusitis: data from the UK National Chronic Rhinosinusitis Epidemiology Study.
Respir Res
. 2018 Jun 27;19(1):129.
21.
Morley AD, Sharp HR. A review of sinonasal outcome scoring systems: which is best?
Clin Otolaryngol
. 2006 Apr;31(2):103–9.
22.
Bachert C, Han JK, Desrosiers M, Hellings PW, Amin N, Lee SE, et al. 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
. 2019 Nov 2;394(10209):1638–50.
23.
Meier EC, Schmid-Grendelmeier P, Steiner UC, Soyka MB. Real-life experience of monoclonal antibody treatments in chronic rhinosinusitis with nasal polyposis.
Int Arch Allergy Immunol
. 2021;182(8):736–43.
24.
Heffler E, Landi M, Caruso C, Fichera S, Gani F, Guidaet G, et al. Nasal cytology: methodology with application to clinical practice and research.
Clin Exp Allergy
. 2018 Sep;48(9):1092–106.
25.
Seccia V, Baldini C, Latorre M, Gelardi M, Dallan I, Cristofani-Mencacci L, et al. Focus on the involvement of the nose and paranasal sinuses in eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome): nasal cytology reveals infiltration of eosinophils as a very common feature.
Int Arch Allergy Immunol
. 2018;175(1–2):61–9.
27.
Brozek JL, Bousquet J, Agache I. Allergic rhinitis and its impact on asthma (ARIA) guidelines: 2016 revision.
J Allergy Clin Immunol
. 2017;140(4):950–8.
28.
Toma S, Hopkins C. Stratification of SNOT-22 scores into mild, moderate or severe and relationship with other subjective instruments.
Rhinology
. 2016 Jun;54(2):129–33.
29.
San Nicoló M, Habermann N, Havel M. AERD associated nasal polyposis: efficacy of postoperative antileukotriene therapy in comparison with aspirin desensitization. A retrospective study.
Int Arch Allergy Immunol
. 2020;181(10):790–8.
30.
Li QC, Cheng KJ, Wang F, Zhou SH. Role of atopy in chronic rhinosinusitis with nasal polyps: does an atopic condition affect the severity and recurrence of disease?
J Laryngol Otol
. 2016 Jul;130(7):640–4.
31.
Benjamin MR, Stevens WW, Li N, Bose S, Grammer LC, Kern RC, et al. Clinical characteristics of patients with chronic rhinosinusitis without nasal polyps in an academic setting.
J Allergy Clin Immunol Pract
. 2019 Mar;7(3):1010–6.
32.
Tripodi S, Frediani T, Lucarelli S, Macrì F, Pingitore G, Di Rienzo Businco A, et al. Molecular profiles of IgE to Phleum pratense in children with grass pollen allergy: implications for specific immunotherapy.
J Allergy Clin Immunol
. 2012 Mar;129(3):834–9.e8.
33.
Huang Y, Wang C, Lin X, Lou H, Cao F, Li W, et al. Association between component-resolved diagnosis of house dust mite and efficacy of allergen immunotherapy in allergic rhinitis patients.
Clin Transl Allergy
. 2019 Dec 19;9:64.
34.
DeYoung K, Wentzel JL, Schlosser RJ, Nguyen SA, Soler ZM. Systematic review of immunotherapy for chronic rhinosinusitis.
Am J Rhinol Allergy
. 2014 Mar–Apr;28(2):145–50.
35.
Mabry RL, Mabry CS. Allergic fungal sinusitis: the role of immunotherapy.
Otolaryngol Clin North Am
. 2000 Apr;33(2):433–40.
© 2022 S. Karger AG, Basel
2022
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.