Dupilumab: An emerging therapy in allergic fungal rhinosinusitis

Bulkhi, Adeeb; Mirza, Ahmad A.; Aburiziza, Abdullah J.; Marglani, Osama

doi:10.1016/j.waojou.2022.100638

Cited by 16 publications

(11 citation statements)

References 30 publications

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“…Unfortunately, there are no data on the effectiveness of specific immunotherapy, but treatment with anti-IgE monoclonal antibodies or blockers of the alpha subunit of the IL-4 or anti-IL-5 receptor gives hope. Biological therapy plays an increasingly important role in AFRS, and the effects of its use are at least promising [29, 32].…”

Section: Discussionmentioning

confidence: 99%

“…Adoption of all the criteria of diagnosis suggested by Bent and Khun seems appropriate, especially in the era of personalized biological treatment. The presence of specific IgE antibodies and inflammatory cytokines characteristic of the first immune mechanism suggests a systemic nature of the disease and makes it possible to introduce additional treatment, such as specific immunotherapy or biological treatment [28‒31]. Unfortunately, there are no data on the effectiveness of specific immunotherapy, but treatment with anti-IgE monoclonal antibodies or blockers of the alpha subunit of the IL-4 or anti-IL-5 receptor gives hope.…”

Section: Discussionmentioning

confidence: 99%

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Allergic Fungal Rhinosinusitis in Europe: Literature Review and Own Experience

Kokoszka¹,

Stryjewska-Makuch²,

Kantczak³

et al. 2023

Int Arch Allergy Immunol

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Allergic fungal rhinosinusitis (AFRS) is primary, Th2-mediated, chronic rhinosinusitis, which is diagnosed when the criteria defined by Bent and Khun are met. The disease is most common in countries located in the subtropical and tropical regions characterized by high temperatures and high levels of humidity, which favour the wider occurrence of fungi in the environment. The presence of specific IgE antibodies directed against fungal allergens, which is one of the diagnostic criteria, proves the systemic nature of the disease and allows one to distinguish AFRS from eosinophilic fungal rhinosinusitis. There is no unified treatment method for AFRS described in the literature, and relapses are common. Sinus surgery remains the treatment of choice. Oral and topical steroid therapy plays an important role in the treatment process. The effectiveness of antifungal treatment and immunotherapy is unclear. Biological treatment, the results of which are promising, has raised great hopes. The aim of this study was to reveal how often AFRS occurs in European countries, what environmental factors influence its development, and how important it is to specify its diagnostic criteria and treatment methods. We present an overview of the available literature. In addition, we share our own experience and describe two cases of AFRS diagnosed and treated at our centre.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Allergic Fungal Rhinosinusitis in Europe: Literature Review and Own Experience

Kokoszka¹,

Stryjewska-Makuch²,

Kantczak³

et al. 2023

Int Arch Allergy Immunol

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“…Multiple case reports demonstrate a benefit in both objective CT scans and subjective SNOT-22 scores in previously recalcitrant AFRS patients after several weeks of dupilumab. 48,49 A recent retrospective case series by Bulkhi et al 50 examined the use of dupilumab in 4 patients with partially or poorly controlled asthma and previously operated AFRS resistant to maximal medical management. At 4 to 6 months after biweekly dupilumab therapy, all 4 patients reported large improvements in SNOT-22 scores (average decrease of 56.25), asthma control tests, pulmonary function tests, and serum eosinophils.…”

Section: Treatment Updatementioning

confidence: 99%

“…This study was limited by the small sample size, and statistics were not available. 50 Mepolizumab is an IL-5-inhibiting monoclonal antibody that is also currently under investigation. The only published study on its effectiveness retrospectively examined 27 recalcitrant AFRS patients with concurrent asthma who received monthly mepolizumab.…”

Section: Treatment Updatementioning

confidence: 99%

New Developments in Allergic Fungal Rhinosinusitis Pathophysiology and Treatment

Cameron

Luong

2023

Am J Rhinol�Allergy

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Background Allergic fungal rhinosinusitis (AFRS) is an endotype of chronic rhinosinusitis (CRS) with nasal polyps characterized by eosinophilic mucin laden with fungal hyphae entrapped in expanded sinus cavities with an exaggerated hypersensitivity to fungal elements. The last decade has elucidated fungi-driven inflammatory pathways contributing to the pathophysiology of chronic inflammatory respiratory diseases. In addition, novel therapeutic biologic options have become available for CRS over the last several years. Objective To review the current literature examining AFRS, focusing on recent developments in our understanding of its pathophysiology and implications for treatment options. Methods Review article. Results Fungi-driven respiratory inflammation has been linked to fungal proteinases and toxin activity. In addition, AFRS patients demonstrate a local sinonasal immunodeficiency in antimicrobial peptides and hence limited antifungal activity, along with an exaggerated type 2 inflammatory response, highlighting a possible imbalanced type 1, type 2, and type 3 profile. The elucidation of these dysregulated molecular pathways has highlighted novel potential therapeutic targets. As such, the clinical management of AFRS, which once included surgery and extended courses of oral corticosteroids, is transitioning away from long courses of oral corticosteroids to incorporate novel delivery mechanisms of topical therapeutic targets and biologics for recalcitrant disease. Conclusion AFRS is an endotype of CRS with nasal polyps (CRSwNP) for which the molecular pathways leading to its inflammatory dysfunction are beginning to be illuminated. In addition to affecting treatment options, these understandings may shape necessary changes to diagnostic criteria and the extrapolated effects of environmental changes on AFRS. More critically, a better appreciation of fungi-driven inflammatory pathways may have implications for the understanding of broader CRS inflammation.

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“…[43,44] No transient elevation of blood eosinophils [45] Avoid anti-IL4R therapy as a first line treatment due to risk of hypereosinophilia [46] ABPA/AFRS Anti-IL4R therapy Most trials excluded AFRS in CRSwNP studies. Some limited evidence to support efficacy [47,48] Anti-IgE, anti-IL5 [49,50] Effective [49,50] However, IgE levels often too high to fit with omalizumab dosing table resulting in high doses prescribed [51] eCRSwNP and eczema/atopic dermatitis Anti-IL4R therapy Demonstrated efficacy [52,53] eCRSwNP and EoE…”

Section: Evaluating Treatment Responsementioning

confidence: 99%

Pulmonology for the rhinologist

Campbell,

Auyeung,

Katsoulotos

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review The upper and lower airways are inter-related despite serving different functions and can no longer be considered separately. Rhinologists are becoming increasingly aware of the role the lower airway plays in optimizing outcomes for their patients. This review highlights recent developments in pulmonology that impact rhinologic conditions. Recent findings The unified airway concept now supports the multidisciplinary management of respiratory and rhinologic pathologies. Biomarkers, biologics and the concept of treatable traits have permitted the development of personalized and precise treatment of the entire respiratory tract. The concept of corticosteroid stewardship, the introduction of steroid sparing agents for the treatment of respiratory diseases and the development of biomarkers, now forces us to be more considerate and precise with oral corticosteroid (OCS) prescribing and to consider reduction regimens. Finally, current research on climate change and vaping will allow us to better educate and prepare our patients to improve adherence and avoid exacerbations to maintain optimal global respiratory health. Summary The inter-relatedness of the upper and lower airway has encouraged a multidisciplinary focus in respiratory medicine. More research is required to improve the precision respiratory medicine model, particularly in the realm of biomarkers and endotyping. These developments must also consider the impact of climate change, pollution and toxins for us to provide optimum care for our patients.

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Dupilumab: An emerging therapy in allergic fungal rhinosinusitis

Cited by 16 publications

References 30 publications

Allergic Fungal Rhinosinusitis in Europe: Literature Review and Own Experience

Allergic Fungal Rhinosinusitis in Europe: Literature Review and Own Experience

New Developments in Allergic Fungal Rhinosinusitis Pathophysiology and Treatment

Pulmonology for the rhinologist

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