Systematic review of immunotherapy for chronic rhinosinusitis.

BACKGROUND: Immunotherapy (IT) has been well established as an effective treatment for allergic rhinitis (AR), but little is known about the benefits of IT on clinical outcomes of comorbid chronic rhinosinusitis (CRS). The goal of this publication is to systematically review the literature regarding outcomes of IT in patients with atopic CRS. METHODS: A systematic review of the literature was conducted including studies that assessed the efficacy of IT on clinical outcome measures in CRS including without polyp, with polyp, and allergic fungal rhinosinusitis subgroups. Excluded articles were those only reporting outcomes specific to asthma or AR. RESULTS: Seven studies met the inclusion and exclusion criteria for this review, none of which were randomized controlled trials. Generally, symptom scores improved in patients treated with IT when compared with baseline data and control patients. Objective endoscopic exam measures improved with IT treatment in short-term studies. Significant improvements were observed in radiographic assessments, and there was a decreased necessity for revision surgery, interventional office visits, and intranasal and oral steroid use. CONCLUSION: Conclusions are limited by the paucity of available data on the efficacy of IT for treating CRS-specific outcome measures. There is weak evidence to support the use of IT as an adjunctive treatment in CRS patients, particularly in the postoperative period.

Leukotriene antagonists in nasal polyposis: a meta-analysis and systematic review.

BACKGROUND: Leukotriene antagonists (LTAs) provide a potential strategy for the management of chronic rhinosinusitis with nasal polyposis (CRSwNP), which is often refractory to medical and surgical treatment. The purpose of this study is to determine the impact of LTA treatment alone and in conjunction with intranasal corticosteroids (INCSs) on nasal symptoms, objective clinical outcomes, and immune parameters in CRSwNP. METHODS: A systematic review was performed including studies that assessed the effectiveness of LTAs on clinical outcome measures of CRSwNP. Exclusion criteria were trials assessing LTAs in CRS without nasal polyps or asthma symptoms only. Quantitative analysis was performed using a random effects model. RESULTS: Twelve studies fulfilled eligibility: five randomized control trials and seven case series. LTAs showed significant improvements in CRSwNP symptoms over placebo; however, these randomized trials were unable to be combined via meta-analysis. The two studies used in meta-analysis showed a standardized mean difference of pooled overall symptom scores of 0.02 (95% confidence interval, -0.39-0.44) between LTA and INCS study arms, indicating no difference between the treatment modalities. Improvement was described by all studies in symptoms, clinical outcomes, and/or immune parameters after LTA treatment, with greater improvements in a subset of symptoms beyond that observed with INCSs. Concomitant asthma, aspirin-exacerbated respiratory disease, and atopy did not significantly or consistently affect these results. CONCLUSION: LTAs are an effective tool for treating CRSwNP, with limited benefit as an adjunctive therapy. Additional study is required to determine the most beneficial strategy and patient population for their use.