Lower Airway Inflammation in Eosinophilic Chronic Rhinosinusitis as Determined by Exhaled Nitric Oxide

Background: A hallmark of eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) is mucosal eosinophil-predominant inflammation. Nasal nitric oxide (nNO) is a known biomarker of eosinophilic inflammation in the upper airway. However, the utility of nNO measurement in the upper airway remains controversial. The present study aimed to compare the use of other clinical parameters with nNO to prediagnose patients with eCRSwNP from Central China. Methods: From June 2019 to December 2019, 70 patients with CRSwNP undergoing endoscopic sinus surgery and 30 healthy subjects were enrolled. nNO measurements were performed in all of these subjects. Computed tomography scans, full blood count with differential analysis, and determination of total immunoglobulin E (total IgE) and plasma cytokines were performed before surgery. Receiver operating characteristic curves and logistic regression analysis were used to assess the predictive potential of the clinical parameters. Results: We recruited 24 patients with eCRSwNP and 46 with noneosinophilic CRSwNP (non-eCRSwNP). In patients with eCRSwNP, nNO levels were significantly higher than those in patients with non-eCRSwNP (p < 0.0001). Blood eosinophil percentages and counts, total IgE, and CT-derived ethmoid sinus and maxillary sinus ratio (E/M ratio) were all significantly higher compared with those in patients with non-eCRSwNP (p < 0.05). To diagnose eCRSwNP, the highest area under the curve (0.803) was determined for nNO. At a cutoff of >329 parts per billion (ppb), the sensitivity was 83.30% and the specificity was 71.70%. However, the levels of plasma cytokines Th1/Th2 were not significantly different between the histological types of CRSwNP (p > 0.05). Conclusion: Measurement of nNO is useful for the early diagnosis of eCRSwNP.

Section: Discussionsupporting

confidence: 92%

Predictive and Diagnostic Value of Nasal Nitric Oxide in Eosinophilic Chronic Rhinosinusitis with Nasal Polyps

Lv¹,

Liu²,

Xiang³

et al. 2020

“…Another important fact is that periostin better reflects chronic type 2-predominant inflammation rather than acute inflammation [19]. According to a recent study by Kambara et al [37], blood eosinophils and FeNO significantly decreased following ESS in CRSwNP [34]. Meanwhile, in patients with ICS-naïve asthma, the decreased rate of serum periostin at 24 weeks after the initiation of ICS treatment (equivalent to fluticasone propionate 400 μg daily) was numerically smaller than that of FeNO (5.4% for serum periostin vs. approximately 25% for FeNO) [38].…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, in patients with ICS-naïve asthma, the decreased rate of serum periostin at 24 weeks after the initiation of ICS treatment (equivalent to fluticasone propionate 400 μg daily) was numerically smaller than that of FeNO (5.4% for serum periostin vs. approximately 25% for FeNO) [38]. Serum periostin levels may not fluctuate by treatment intervention for the short term, unlike blood eosinophils and FeNO [37].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Increased Serum Periostin Levels and Eosinophils in Nasal Polyps Are Associated with the Preventive Effect of Endoscopic Sinus Surgery for Asthma Exacerbations in Chronic Rhinosinusitis Patients

Kanemitsu

Kurokawa

Ono³

et al. 2020

Background: Eosinophilic nasal polyps (NPs) are associated with the presence of asthma in chronic rhinosinusitis (CRS) patients. Serum periostin has been considered a relevant biomarker for unified airway diseases. Objective: To determine the utility of biomarkers including serum periostin that reflects reduction of exacerbations of comorbid asthma in CRS patients. Methods: We prospectively recruited 56 CRS patients who were subjected to undergo endoscopic sinus surgery (ESS) (20 with asthma) between October 2015 and December 2017 and followed them for 1 year after ESS. Blood eosinophil count, serum periostin, and fractional nitric oxide (FeNO) were measured at enrollment. How these type 2-driven biomarkers reflect comorbid asthma was determined using receiver operating characteristic (ROC) analysis. The frequency of asthma exacerbations during 1 year was counted both before and after ESS. Associations between preoperative biomarkers including eosinophils in NPs and asthma exacerbations were evaluated. Results: Blood eosinophil count, FeNO, and serum periostin levels were significantly higher in CRS patients with asthma than in those without (p < 0.01 for all) and discriminated comorbid asthma among CRS patients (p < 0.05; AUC > 0.80 for all). The increased preoperative serum periostin correlated with lower absolute number of postoperative exacerbations (ρ = −0.49, p = 0.03) and its relative reduction after ESS (ρ = 0.53, p = 0.03) in asthmatic patients. Increased eosinophils in NPs were also associated with reduced asthma exacerbations. Conclusion: Preoperative increased serum periostin and eosinophils in NPs are associated with the preventive effect of ESS for asthma exacerbations in CRS patients comorbid with asthma.

“…Chronic allergic sinusitis has been associated with allergy to aeroallergens; however, over 80% of patients with chronic sinusitis are also sensitized to food allergens though without any difference between the groups with and without nasal polyps [24]. In eosinophilic chronic rhinosinusitis (ECRS) the inflammation extends to the lower airways, as indicated by elevated FeNO, and endoscopic sinus surgery may improve both ECRS and pulmonary dysfunction [25]. It is noteworthy that, upon chemotherapy, allergen-specific IgE levels significantly decrease, but do not disappear, suggesting that some plasma cells survive, still producing IgE [26].…”

Section: Characterization Of Subgroups Of Allergic Rhinitismentioning

confidence: 99%

Recent Advances in Clinical Allergy and Immunology

Simon

2018

Allergic diseases are of great concern because of their high prevalence, which is still rising in several regions, their impact on patients’ physical and psychological health, the huge burden they place on patients’ quality of life, as well as the socioeconomic consequences that they cause. Recent research has provided new data on both genetic and environmental risk factors of atopic/allergic diseases. The application of new technologies such as “omics” has allowed a better understanding of the pathogenesis and has helped with the identification of therapeutic targets. Immense progress has been made in developing and applying novel, targeted therapies, for example for asthma and urticaria. Intensive efforts are being made to find biomarkers that help to classify patients, to identify their potential responsiveness to specific therapies, and to monitor the disease severity. Based on recent insights in the pathogenesis of food allergy and drug hypersensitivity, novel strategies for diagnostics, allergen avoidance, and induction of tolerance have been developed. Here, we summarize important findings in the field of clinical allergy and immunology with a special focus on asthma, allergic rhinitis, atopic dermatitis, food allergy, urticaria, angioedema, and drug hypersensitivity.