Allergic phenotype of chronic rhinosinusitis based on radiologic pattern of disease

Hamizan, Aneeza Khairiyah Wan; Loftus, Patricia A.; Alvarado, Raquel; Ho, Jacqueline J; Kalish, Larry; Sacks, Raymond; DelGaudio, John M.; Harvey, Richard J.

doi:10.1002/lary.27180

Cited by 51 publications

(107 citation statements)

References 15 publications

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“…Inhalant allergen deposition in these central compartment structures is related to the course of normal nasal airflow. Our group and others have previously reported a strong association between CCAD and allergy . In our clinical practice, we have also noted a low association of CCAD with asthma.…”

supporting

confidence: 79%

“…Our group and others have previously reported a strong association between CCAD and allergy. 7,8 In our clinical practice, we have also noted a low association of CCAD with asthma.…”

mentioning

confidence: 63%

“…AERD was diagnosed based on presence of asthma and nasal polyposis, as well as a history of positive aspirin challenge or respiratory reaction to aspirin or nonsteroidal anti‐inflammatory drugs . CCAD was diagnosed based on endoscopic findings of inflammation/polypoid changes located within the central compartment (NS, MT, ST) . For this study, isolated MT polyp patients were included in the CCAD cohort.…”

Section: Methodsmentioning

confidence: 99%

“…Confirmation of allergy testing results was obtained for patients tested before presentation to our institution. For those tested at our institution, the protocol was performed as described elsewhere …”

Section: Methodsmentioning

confidence: 99%

“…5,6 CCAD, described in 2017, is a nasal inflammatory polypoid condition strongly associated with inhalant allergy, involving the superior nasal septum (NS) with or without the MT and/or superior turbinate (ST). 7,8 Inhalant allergen deposition in these central compartment structures is related to the course of normal nasal airflow. Our group and others have previously reported a strong association between CCAD and allergy.…”

mentioning

confidence: 99%

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Central compartment atopic disease: prevalence of allergy and asthma compared with other subtypes of chronic rhinosinusitis with nasal polyps

Marcus

Schertzer

Roland

et al. 2019

Int Forum Allergy Rhinol

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102

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Background Central compartment atopic disease (CCAD) is a recently described variant of chronic rhinosinusitis with nasal polyp (CRSwNP) associated with inhalant allergy. An association with asthma was noted to be uncommon within our clinical practice. The purpose of this study was to determine allergy and asthma prevalence in CCAD and other CRSwNP subtypes. Methods A retrospective analysis at a tertiary care institution was performed over the period from 2015 to 2019. CRSwNP was grouped into the following subtypes: allergic fungal rhinosinusitis (AFRS); aspirin‐exacerbated respiratory disease (AERD); CCAD; and CRSwNP not otherwise specified (CRSwNP NOS). Patients with sinonasal polyps and concomitant polypoid disease in the central compartment (CRSwNP/CC) were analyzed as a separate cohort for the purpose of this study. Prevalence of allergy and asthma was compared between groups. Results Three hundred fifty‐six patients were included. CRSwNP NOS was the most common subtype (37.1%) and CRSwNP/CC was the least common (3.7%), with other CRS subtypes ranging between 11.5% and 24.2%. Asthma prevalence was highest in AERD (100%) and CRSwNP NOS (37.1%), but substantially lower in AFRS (19.0%) and CCAD (17.1%). Asthma was significantly more common in AERD and CRSwNP NOS when compared with CCAD (p < 0.001 and p = 0.039, respectively). Prevalence of allergy was significantly higher in AFRS (100%), CCAD (97.6%), CRSwNP/CC (84.6%), and AERD (82.6%) when compared with CRSwNP NOS (56.1%) (p < 0.001). Conclusion CCAD represents a clinically distinct phenotype of CRSwNP with a high prevalence of allergy and low prevalence of asthma. Patients with both CCAD and diffuse sinonasal polyps had an allergy prevalence approaching that of CCAD and an asthma prevalence approaching CRSwNP NOS.

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supporting

confidence: 79%

“…Our group and others have previously reported a strong association between CCAD and allergy. 7,8 In our clinical practice, we have also noted a low association of CCAD with asthma.…”

mentioning

confidence: 63%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Central compartment atopic disease: prevalence of allergy and asthma compared with other subtypes of chronic rhinosinusitis with nasal polyps

Marcus

Schertzer

Roland

et al. 2019

Int Forum Allergy Rhinol

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102

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Contemporary Classification of Chronic Rhinosinusitis Beyond Polyps vs No Polyps

Grayson

Hopkins

Mori

et al. 2020

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Chronic rhinosinusitis (CRS) is a broadly defined process that has previously been used to describe many different sinonasal pathologic conditions from odontogenic sinusitis and allergic fungal sinusitis to the more contemporary definition of broad inflammatory airway conditions. Previous classification systems have dichotomized these conditions into CRS with nasal polyps and CRS without nasal polyps. However, clinicians are learning more about the inflammatory subtypes of CRS, which can lead to improved delivery and effectiveness of treatment.OBSERVATIONS In clinical practice, treatment decisions are often based on observable findings, clinical history, presumed disease, and molecular pathophysiologic characteristics. A proposed classification system is simple and practical. It proposes that the functional anatomical compartments involved create the first level of separation into local and diffuse CRS, which are usually unilateral or bilateral in distribution. Diffuse does not imply "pansinusitis" but simply that the disease is not confined to a known functional anatomical unit. This classification takes into account whether local anatomical factors are associated with pathogenesis. Then the inflammatory endotype dominance is separated into a type 2 skewed inflammation, as this has both causal and treatment implications. The non-type 2 CRS encompasses everything else that is not yet known about inflammation and may change over time. The phenotypes or clinical examples are CRS entities that have been described and how they align with this system. CONCLUSIONS AND RELEVANCEAlthough research continues to further define the subtypes of CRS into phenotypes and endotypes, the proposed classification system of primary CRS by anatomical distribution and endotype dominance allows for a pathway forward.

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Atopy in chronic rhinosinusitis: impact on quality of life outcomes

Alvarado

Rimmer

et al. 2019

Int Forum Allergy Rhinol

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Background: Chronic rhinosinusitis (CRS), in particular with nasal polyps (CRSwNP), has been linked with skewed T-helper 2 and immunoglobulin E (IgE)-mediated allergic responses. The role of atopy in CRS, however, remains unclear. Correlations between immunological allergic markers and patient-reported outcomes measures (PROMs) were investigated. Methods:A cross-sectional study of adult patients with CRS undergoing endoscopic sinus surgery was conducted. Immunological allergic markers included automated immunoassay testing for serum-specific IgE to common allergens (house dust mite, grass, mold, animal epithelia) and total IgE. PROMs were assessed using the 22-item Sino-Nasal Outcome Test (SNOT-22). Patients were defined as atopic based on either a positive specific IgE or elevated total IgE (>160 kU/L). Results:A total of 446 patients (45.7% female, age 49.05 ± 14.96 years) were recruited, of which 42.8% had asthma, 51.6% had CRSwNP, and 63.0% had eosinophilic CRS. Positive allergen sensitization was detected in 52.9% patients. Total IgE levels were elevated in 28.0% with mean IgE level of 161 ± 269 kU/L. Atopy was associated with younger age at the time of surgery, CRSwNP, asthma, and eosinophilic CRS (eCRS). Atopy was also associated with increased severity in nasal symptom score (13.1 ± 6.4 vs 11.9 ± 6.0, p = 0.04), as well as worse scores in the loss of smell/taste (χ 2 (1) = 5.97, p = 0.02) and need to blow nose (χ 2 (1) = 4.26, p = 0.04) questions in the CRS population. In the CRSwNP population, there was no significant association between atopy and PROMs. Conclusion:Comorbid atopy in CRS is associated with additional symptom burden, reflected mainly within the nasal symptom quality of life markers. Atopy assessment in CRS is important to ensure appropriate and successful treatment of the disease. C 2018 ARS-AAOA, LLC.

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Allergic phenotype of chronic rhinosinusitis based on radiologic pattern of disease

Abstract: 3b Laryngoscope, 128:2015-2021, 2018.

Cited by 51 publications

References 15 publications

Central compartment atopic disease: prevalence of allergy and asthma compared with other subtypes of chronic rhinosinusitis with nasal polyps

Central compartment atopic disease: prevalence of allergy and asthma compared with other subtypes of chronic rhinosinusitis with nasal polyps

Contemporary Classification of Chronic Rhinosinusitis Beyond Polyps vs No Polyps

Atopy in chronic rhinosinusitis: impact on quality of life outcomes

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