Published Online: December 2015
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a challenge for Allergy and ENT specialists. The disease recurs in up to 80% of patients after sinus surgery followed by medical treatment, and about 40% of patients may need at least one further surgery over the next 10 years. Furthermore, patients with nasal polyps may develop asthma comorbidity in about 40%. Recent studies on the underlying endotypes in nasal polyps pointed out that disease recurrence and asthma development are both associated with a Th2-bias, eosinophilia and IgE formation in polyp tissue; the presence of specific IgE antibodies to staphylococcal superantigens was the strongest categorical value associated with asthma risk.
In a review recently published in The Journal of Allergy & Clinical Immunology (JACI), Bachert et al. presented the current gaps in our pharmacological approaches to this disease, either due to a moderate efficacy of current options (e.g. for topical nasal corticosteroid spray), or the high risk of adverse events (e.g. from systemic corticosteroids). They then summarized the current status of research involving human or humanized monoclonal antibodies (hmabs) for the treatment of patients with nasal polyps. Studies targeting interleukins-5, -4 and -13, as well as IgE resulted in clinically relevant reductions of nasal polyp sizes and symptoms similar to those of oral corticosteroid therapy over 3 weeks. In contrast to oral corticosteroids, however, hmabs provide longer duration of treatment effects and less risk for systemic adverse events.
Although none of these hmabs is currently indicated for patients with nasal polyps, there already is a body of clinical experience with omalizumab use in patients with comorbid severe asthma. The authors also discuss several new treatments in development for patients with nasal polyps, including the GATA3 DNA-zyme which silences GATA-3, the most relevant transcription factor for innate and adaptive type-2 related cells (Th2-cells and ILC2s), reducing all of the above mentioned cytokines in ex-vivo nasal polyp tissue experiments. In the near future, it is hoped that innovative approaches using hmabs may reduce need for nasal polypectomies.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.