Insights into the Implications of Coexisting Type 2 Inflammatory Diseases

Abstract

The role of type 2 inflammation in the pathogenesis of certain human diseases is an area of active investigation. Certain asthma, atopic dermatitis, eosinophilic esophagitis, and chronic rhinosinusitis phenotypes are characterized by a Th2 predominant inflammatory pathway and are frequently associated with comorbid conditions in patients. The purpose of this article is to review the evidence behind concurrent Th2-mediated diseases and explore how the presence of these comorbid conditions affect patient and disease outcomes.

White Paper on European Patient Needs and Suggestions on Chronic Type 2 Inflammation of Airways and Skin by EUFOREA

“…A recent study demonstrated the concurrent efficacy of Dupilumab in AD, asthma and chronic sinonasal conditions, however, the question of whether a unique therapy could lead to a concomitant improvement of all the aforementioned diseases still remains to be further investigated ( 2 , 33 ). Multiple data already exist showing an improvement in asthma after treatment of CRSwNP and vice versa ( 1 , 2 , 7 , 12 ), supporting the link between upper and lower airway diseases ( 5 , 36 ). In parallel, future research should establish whether biologics should be used in case of moderate CRSwNP and moderate asthma and whether use of biologics can prevent the development of other Type 2 comorbidities and similarly prevent the need for surgical interventions ( 12 ).…”

“…Biologics are monoclonal antibodies that, in this case, target Type 2 mediators. Asthma, AD and CRSwNP are inflammatory diseases among subgroups that share common pathophysiological mechanisms which explain their frequent co-existence ( 1 , 2 ). Targeting the key drivers of Type 2 inflammation has a therapeutic effect on both AD, asthma and CRSwNP ( 12 , 33 , 34 ).…”

“…Chronic rhinosinusitis with nasal polyps (CRSwNP), asthma and atopic dermatitis (AD) are chronic inflammatory diseases of the upper airways, lower airways and the skin, respectively. The majority of these patients share a common pathogenesis, called Type 2 inflammation, with different T-helper 2 and ILC2 (type 2 innate lymphoid cells) cytokines driving the chronicity of inflammation in the different organs ( 1 , 2 ). Globally, the prevalence of Type 2 inflammatory diseases is increasing with CRSwNP, asthma and AD currently affecting up to 3%, 1–18% and 10% of the population respectively ( 3 – 5 ).…”

“…Patients with CRSwNP, asthma and AD frequently have Type 2 comorbidities, with asthma occurring in up to 65% of patients with CRSwNP and in up to 49.8% of patients with AD ( 6 – 8 ). Although limited studies have investigated the prevalence of comorbid AD and CRSwNP, it is known that there is somewhat an association between the diagnosis of AD and the development of CRSwNP ( 1 , 9 ). Furthermore, the severity of CRSwNP, asthma and AD is higher when concomitant Type 2 comorbidities exist, with suboptimal outcomes in care if comorbidities are neglected ( 10 , 11 ), including high recurrence rates and the frequent need for systemic corticosteroids ( 5 , 12 ).…”

Two is better than one: Effectiveness of dupilumab on atopic dermatitis and chronic rhinosinusitis with nasal polyps in an adolescent

“…8 Chronicity and high impact on QoL of these conditions need a targeted and effective long-term treatment. 8 Current therapeutic approach focuses on controlling inflammation, which is characterized by massive tissue T-helper (Th)2 cell infiltration and increased levels of Th2 cytokines, mostly IL-4 and IL-13. 8 By blocking IL-4 and IL-13 overexpression, dupilumab has been demonstrated to be effective in type 2-related diseases, with few and well-tolerated AEs.…”