Prevalence of asthma, aspirin sensitivity and allergy in chronic rhinosinusitis: data from the UK National Chronic Rhinosinusitis Epidemiology Study

Abstract

BackgroundChronic rhinosinusitis (CRS) is a common disorder associated with other respiratory tract diseases such as asthma and inhalant allergy. However, the prevalence of these co-morbidities varies considerably in the existing medical literature and by phenotype of CRS studied. The study objective was to identify the prevalence of asthma, inhalant allergy and aspirin sensitivity in CRS patients referred to secondary care and establish any differences between CRS phenotypes.MethodsAll participants were diagnosed in secondary care according to international guidelines and invited to complete a questionnaire including details of co-morbidities and allergies. Data were analysed for differences between controls and CRS participants and between phenotypes using chi-squared tests.ResultsThe final analysis included 1470 study participants: 221 controls, 553 CRS without nasal polyps (CRSsNPs), 651 CRS with nasal polyps (CRSwNPs) and 45 allergic fungal rhinosinusitis (AFRS). The prevalence of asthma was 9.95, 21.16, 46.9 and 73.3% respectively. The prevalence of self-reported confirmed inhalant allergy was 13.1, 20.3, 31.0 and 33.3% respectively; house dust mite allergy was significantly higher in CRSwNPs (16%) compared to CRSsNPs (9%, p < 0.001). The prevalence of self- reported aspirin sensitivity was 2.26, 3.25, 9.61 and 40% respectively. The odds ratio for aspirin sensitivity amongst those with AFRS was 28.8 (CIs 9.9, 83.8) p < 0.001.ConclusionsThe prevalence of asthma and allergy in CRS varies by phenoytype, with CRSwNPs and AFRS having a stronger association with both. Aspirin sensitivity has a highly significant association with AFRS. All of these comorbidities are significantly more prevalent than in non-CRS controls and strengthen the need for a more individualised approach to the combined airway.

The role of biologics in chronic rhinosinusitis: a systematic review

“…However, further research determined that the immunologic profile is much more complex and different endotypes of CRS exist based on the involvement of specific inflammatory mediators, either at the molecular or cellular level. Both CRSsNP and CRSwNP are associated with asthma, inhalant allergy, and aspirin hypersensitivity . However, there is a higher prevalence in the CRSwNP phenotype .…”

“…6 However, there is a higher prevalence in the CRSwNP phenotype. 6 Consequently, the evidence for biologics in CRS stems from research done primarily on patients with asthma and AR. The etiology of CRS is still poorly understood.…”

EUFOREA consensus on biologics for CRSwNP with or without asthma

“…Using patient questionnaires to measure the prevalence of CRSwNP yielded estimates of 2.1% (France) to 4.3% (Finland) in Europe and 1.1% in China . CRSwNP comprises a heterogeneous group of patients who differ with respect to coexisting asthma, allergy, NSAID‐exacerbated respiratory disease (N‐ERD), smoking, age of onset, and disease severity . Asthma affects 30%‐70% of the CRSwNP patients .…”

“…8 CRSwNP comprises a heterogeneous group of patients who differ with respect to coexisting asthma, allergy, NSAID-exacerbated respiratory disease (N-ERD), 9 smoking, age of onset, and disease severity. [10][11][12] Asthma affects 30%-70% of the CRSwNP patients. 8,10,13,14 Conversely, the presence of nasal polyps is associated with the severity of asthma, regardless of smoking status ranging from 10%-30% in mild asthma to 70%-90% in severe asthma.…”

“…[10][11][12] Asthma affects 30%-70% of the CRSwNP patients. 8,10,13,14 Conversely, the presence of nasal polyps is associated with the severity of asthma, regardless of smoking status ranging from 10%-30% in mild asthma to 70%-90% in severe asthma. 15,16 Both CRSwNP and asthma share common underlying pathophysiological mechanisms driving the disease (endotype), of which type 2 inflammation is the most prominent.…”