Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
J Allergy Clin Immunol Pract. 2020 May;8(5):1522-1531. doi: 10.1016/j.jaip.2020.01.031. Epub 2020 Jan 28.
Advances in understanding the pathogenic mechanisms of both rhinitis and chronic rhinosinusitis have resulted in new treatment options, especially for chronic rhinosinusitis. A review of relevant medical and surgical clinical studies shows that intranasal corticosteroids, antihistamines, and allergen immunotherapy continue to be the best treatments for chronic rhinitis. Dupilumab is the first biologic approved for chronic rhinosinusitis with polyps. Omalizumab, mepolizumab, and benralizumab may have a future role in the treatment of chronic rhinosinusitis. Novel corticosteroid delivery devices such as an exhalation delivery system for fluticasone and bioabsorbable sinus implants provide enhanced and localized distribution of corticosteroids. Surgical management tailored to the underlying disease process improves clinical outcomes in chronic rhinosinusitis with or without nasal polyposis. Advances in the understanding of the heterogeneous nature of rhinitis and rhinosinusitis have resulted in more precise treatments. Improving the understanding of different endotypes should provide better knowledge to determine appropriate current and new therapies to treat these diseases.
对鼻炎和慢性鼻-鼻窦炎发病机制的深入了解，带来了新的治疗选择，尤其是针对慢性鼻-鼻窦炎。对相关医学和外科临床研究的回顾表明，鼻内皮质类固醇、抗组胺药和过敏原免疫疗法仍然是治疗慢性鼻炎的最佳方法。度普利尤单抗是第一种获批用于治疗鼻息肉型慢性鼻-鼻窦炎的生物制剂。奥马珠单抗、美泊利单抗和贝那利珠单抗可能在慢性鼻-鼻窦炎的治疗中发挥未来作用。新型皮质类固醇输送装置，如氟替卡松呼气输送系统和可生物吸收的鼻窦植入物，提供了皮质类固醇的增强和局部分布。针对潜在疾病过程的手术管理，改善了有或无鼻息肉的慢性鼻-鼻窦炎的临床结果。对鼻炎和鼻-鼻窦炎异质性本质的认识的提高，导致了更精确的治疗方法。对不同表型的深入了解，应该能提供更好的知识，以确定当前和新的治疗方法来治疗这些疾病。
