EOSINOPHILIC IMMUNE DYSFUNCTION
ACROSS INFLAMMATORY DISEASESCHRONIC RHINOSINUSITIS WITH NASAL POLYPS (CRSwNP)
CHRONIC RHINOSINUSITIS WITH NASAL POLYPS (CRSwNP)
Eosinophilic
asthma (EA)
Chronic rhinosinusitis with nasal polyps (CRSwNP)
Eosinophilic
esophagitis (EoE)
Eosinophilic granulomatosis with polyangiitis (EGPA)
Hyper eosinophilic
syndrome (HES)
WHAT IS CHRONIC RHINOSINUSITIS WITH NASAL POLYPS (CRSwNP)?
Chronic rhinosinusitis (CRS) is characterized by persistent, symptomatic
inflammation of the mucosa of the nose and paranasal sinuses.1
Nasal polyps (NP) are benign inflammatory masses arising from the
mucosa of the nose and paranasal sinuses.2
The estimated prevalence of CRSwNP is 1%-4%.3,4
Approximately
1 in 20
people have CRS
(2007 US Survey)5
Up to 30%
of patients
with CRS have CRSwNP in the US6
~60 to 90%
of CRSwNP
patients have eosinophil-dominant infiltration
(Using the definition of >=5-10 eosinophils / field magnification X400)7-9
THE ROLE OF EOSINOPHILIC IMMUNE DYSFUNCTION IN CHRONIC RHINOSINUSITIS WITH NASAL POLYPS
Eosinophilic inflammation can potentially contributes to key pathological
mechanisms in chronic rhinosinusitis with nasal polyps.10-14
These eosinophil-derived substances result in the above effects in diseases, including nasal polyps. The above table summarizes the proposed effects in nasal polyps.10
ECP=eosinophil cationic protein; EDN=eosinophil-derived neurotoxin; EPX=eosinophil peroxidase; GM-CSF=granulocyte-macrophage colony-stimulating factor; MBP=major basic protein; MMP=matrix metalloproteinase; RANTES=regulated on activation, normal T cells expressed and secreted; TGF=transforming growth factor.
THE CLINICAL CONSEQUENCES OF CHRONIC
RHINOSINUSITIS WITH NASAL POLYPS
Clinical manifestations of CRSwNP: nasal obstruction, reduction in sense of smell, nasal discharge,
sleep disturbance, and adverse effects on quality of life.23-25
Surgery to remove polyps may be required in patients whose symptoms are not controlled with
corticosteroids. However, rates of relapse and repeated intervention can be high.23-24