Allergy Clinic, Casa di Cura Villa Montallegro, Genoa.
Department of Otolaryngology, University of Foggia.
Monaldi Arch Chest Dis. 2021 Mar 8;91(3). doi: 10.4081/monaldi.2021.1769.
Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a common disorder. From a clinical and immunopathological point of view, different phenotypes and endotypes have been identified. As asthma is frequent comorbidity, biological agents for treating CRSwNP associated with asthma may be an attractive strategy. Biological agents have several mechanisms, such as antagonizing IgE, interleukin (IL) 4, IL-5, and IL-13. However, a workup is mandatory, mainly concerning pheno-endotyping. In this regard, clinical cytological grading (CCG) has been proposed as a useful tool to manage patients with CRSwNP as it allows us to define clinical and immunopathological phenotypes able to identify the ideal candidate for biologics. In particular, the mixed cellular pattern, such as eosinophils and mast cells, could be sensitive to anti-IL-4 agents. There is still a need for well-established indications, criteria of responsiveness, duration, and safety. Moreover, personalized medicine could be opportunely integrated and/or alternated with intranasal corticosteroids to prevent relevant adverse events.
伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）是一种常见疾病。从临床和免疫病理学的角度来看，已经确定了不同的表型和内型。由于哮喘是常见的合并症，因此治疗与哮喘相关的 CRSwNP 的生物制剂可能是一种有吸引力的策略。生物制剂具有多种机制，例如拮抗 IgE、白细胞介素 (IL) 4、IL-5 和 IL-13。然而，必须进行检查，主要是表型-内型检查。在这方面，已经提出了临床细胞学分级 (CCG) 作为管理 CRSwNP 患者的有用工具，因为它允许我们定义能够识别生物制剂理想候选者的临床和免疫病理学表型。特别是，混合细胞模式，如嗜酸性粒细胞和肥大细胞，可能对抗 IL-4 药物敏感。仍然需要确立明确的适应证、反应标准、持续时间和安全性。此外，个性化药物可以适当地与鼻内皮质类固醇结合和/或交替使用，以预防相关的不良事件。
