African American Patients with Chronic Rhinosinusitis Have a Distinct Phenotype of Polyposis Associated with Increased Asthma Hospitalization

Mahdavinia, Mahboobeh; Benhammuda, Mohamed; Codispoti, Christopher D.; Tobin, Mary C.; Losavio, Philip S.; Mehta, Arpita; Jeffe, Jill S.; Bandi, Sindhura; Peters, Anju T.; Stevens, Whitney W.; Landay, Alan; Keshavarzian, Ali; Schleimer, Robert P.; Batra, Pete S.

doi:10.1016/j.jaip.2015.11.031

Cited by 29 publications

(23 citation statements)

References 27 publications

(38 reference statements)

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“…43,44 African-American patients also seem to have more severe sinus disease. 45 Our study indicates that similar disparities exist in AERD, specifically with regard to aspirin treatment outcomes.…”

Section: Discussionsupporting

confidence: 61%

Plasma 15-Hydroxyeicosatetraenoic Acid Predicts Treatment Outcomes in Aspirin-Exacerbated Respiratory Disease

Jerschow

Edin

Pelletier

et al. 2017

The Journal of Allergy and Clinical Immunology: In Practice

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Background Aspirin desensitization followed by daily aspirin provides therapeutic benefits to patients with aspirin exacerbated respiratory disease (AERD). It is not well understood how eicosanoid levels change during aspirin treatment. Objective To investigate associations between clinical outcomes of aspirin treatment and plasma eicosanoid levels in AERD patients. Methods Thirty-nine AERD patients were offered aspirin treatment (650 mg twice daily) for four weeks. Respiratory parameters and plasma levels of multiple eicosanoids were recorded at baseline and after four weeks of aspirin therapy using the Asthma Control Test (ACT) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Respiratory function was evaluated using the forced expiratory volume in 1 second (FEV1) and nasal peak flow (NPF). Results After aspirin treatment, respiratory symptoms improved in sixteen patients, worsened in twelve patients, and did not change in four. Seven patients were unable to complete the desensitization protocol. Patients with symptom improvement had higher baseline plasma 15-hydroxyeicosatetraenoic acid (15-HETE) levels than patients with symptom worsening: 7006 (IQR 6056-8688) vs. 4800 (IQR 4238-5575) pg/ml, p=0.0005. Baseline 15-HETE plasma levels positively correlated with the change in ACT score (r=0.61, p=0.001) and in FEV1 after four weeks of aspirin treatment (r=0.49, p=0.01). It inversely correlated with RQLQ score (r=−0.58, p=0.002). African-American and Latino patients were more likely to have symptom worsening on aspirin or fail to complete the initial desensitization than White, Non-Latino patients (p=0.02). Conclusions In AERD patients, low baseline 15-HETE plasma levels and African-American or Latino ethnicity are associated with worsening of respiratory symptoms during aspirin treatment.

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Section: Discussionsupporting

confidence: 61%

Plasma 15-Hydroxyeicosatetraenoic Acid Predicts Treatment Outcomes in Aspirin-Exacerbated Respiratory Disease

Jerschow

Edin

Pelletier

et al. 2017

The Journal of Allergy and Clinical Immunology: In Practice

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“…Those African-American CRS patients with polypoid disease had a history of more hospitalizations for asthma. These findings suggest that African-Americans, who are known to have higher prevalence and worse severity of asthma, also have worse CRSwNP than patients from other races (167). Pinto et al (168) reported that African-American CRS patients had lower vitamin D levels than control African-American patients, and Bush et al (169) reported that surgical outcomes were not as durable in African-American patients with polypoid CRS and asthma compared with Caucasian patients.…”

Section: Race Eosinophilia and Crs: What Are The Roles Of Genes Andmentioning

confidence: 90%

Immunopathogenesis of Chronic Rhinosinusitis and Nasal Polyposis

Schleimer

2017

Annu. Rev. Pathol. Mech. Dis.

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392

419

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Chronic rhinosinusitis (CRS) is a troublesome, chronic inflammatory disease that affects over 10% of the adult population, causing decreased quality of life, lost productivity, and lost time at work and leading to more than a million surgical interventions annually worldwide. The nose, paranasal sinuses, and associated lymphoid tissues play important roles in homeostasis and immunity, and CRS significantly impairs these normal functions. Pathogenic mechanisms of CRS have recently become the focus of intense investigations worldwide, and significant progress has been made. The two main forms of CRS that have been long recognized, with and without nasal polyps, are each now known to be heterogeneous, based on underlying mechanism, geographical location, and race. Loss of the immune barrier, including increased permeability of mucosal epithelium and reduced production of important antimicrobial substances and responses, is a common feature of many forms of CRS. One form of CRS with polyps found worldwide is driven by the cytokines IL-5 and IL-13 coming from Th2 cells, type 2 innate lymphoid cells, and probably mast cells. Type 2 cytokines activate inflammatory cells that are implicated in the pathogenic mechanism, including mast cells, basophils, and eosinophils. New classes of biological drugs that block the production or action of these cytokines are making important inroads toward new treatment paradigms in polypoid CRS.

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“…We previously found that the phenotype of CRS is different and more severe in African Americans. 16 African American patients with CRS have a higher CRS severity index on computed tomography (LMS) and increased smell loss than white patients with CRS. 16 In our current study, no association was found between OSA and higher LMS.…”

Section: Discussionmentioning

confidence: 99%

“…We reviewed the medical records of all patients in our previously reported large retrospective cohort of CRS. 16,17 CRS was diagnosed per the American Academy of Otolaryngology–Head and Neck Surgery Chronic Rhinosinusitis Task Force criteria, 18 with more than 12 weeks of continuous rhinosinusitis symptoms, along with nasal endoscopy or computed tomography demonstrating objective findings of sinusitis.…”

Section: Methodsmentioning

confidence: 99%

Risk of obstructive sleep apnea in African American patients with chronic rhinosinusitis

Hui

Ong

Herdegen

et al. 2017

Annals of Allergy, Asthma & Immunology

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Background It is widely known that patients with chronic rhinosinusitis (CRS) commonly experience sleep disruption. Many of these patients have the associated diagnosis of obstructive sleep apnea (OSA). However, little is known about the risk factors for developing OSA in the CRS population. Objective To identify the risk factors for OSA in CRS to determine who should be screened for OSA among patients with CRS. Methods We evaluated a large cohort of patients with confirmed diagnostic criteria for CRS. Patient medical records were reviewed to identify those with OSA confirmed by overnight polysomnography. Records were further reviewed for demographic information (age, sex, race, and ethnicity), body mass index, and medical history, including the presence of nasal polyps, asthma, aspirin-exacerbated respiratory disease, allergic rhinitis, and eczema. The number of endoscopic sinus operations, duration of CRS, presence of subjective smell loss, and computed tomography Lund-Mackay score were also ascertained. Results A total of 916 patients with CRS were included in the study. Implementation of a multivariable regression model for identifying adjusted risk factors revealed that African American patients had a significantly higher risk for OSA than white patients, with an adjusted odds ratio of 1.98 (95% confidence interval,1.19–3.29). Furthermore, patients with CRS without nasal polyps were at higher risk for OSA, with an odds ratio of 1.63 (95% confidence interval, 1.02–2.61) compared with patients with CRS with nasal polyps. Conclusion African American patients with CRS were at higher risk for OSA compared with white patients, and this patient group needs to be screened for OSA.

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African American Patients with Chronic Rhinosinusitis Have a Distinct Phenotype of Polyposis Associated with Increased Asthma Hospitalization

Cited by 29 publications

References 27 publications

Plasma 15-Hydroxyeicosatetraenoic Acid Predicts Treatment Outcomes in Aspirin-Exacerbated Respiratory Disease

Plasma 15-Hydroxyeicosatetraenoic Acid Predicts Treatment Outcomes in Aspirin-Exacerbated Respiratory Disease

Immunopathogenesis of Chronic Rhinosinusitis and Nasal Polyposis

Risk of obstructive sleep apnea in African American patients with chronic rhinosinusitis

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