Current and emerging biological therapies for Chronic rhinosinusitis with nasal polyps with type 2 inflammation.

INTRODUCTION: Chronic rhinosinusitis with nasal polyps (CRSwNP), especially CRSwNP with type 2 inflammation, remains the most difficult-to-treat subtype with high prevalence worldwide. The emergence of biologics has the potential to fulfill the unmet medical needs of patients with CRSwNP driven by type 2 inflammation. AREAS COVERED: A current review of the literature was performed to overview current and emerging biological therapies in the treatment of CRSwNP. EXPERT OPINION: In an era of precision medicine, biologics have been given expectations to provide customized therapies to patients with CRSwNP, particularly those with refractory CRSwNP. Large clinical trials and real-world experiences are both essential for the application of biologics. Moreover, to make biological therapy more tailored to patients, an in-depth understanding of the different mechanisms of biologics, further elucidating the relationship between biologics and conventional medical and surgical treatments, and identifying predictive biomarkers warrant thorough investigations.

M2 Macrophages Upregulated by Allergen Exposure in Seasonal Allergic Rhinitis.

INTRODUCTION: Macrophages play a central role in balancing the immune response by switching phenotypes between the M1 and M2 profiles according to a delicate equilibrium. Based on a previous clinical trial (NCT03649139), this study aimed to evaluate the change in M2 macrophages during pollen exposure in seasonal allergic rhinitis (SAR). METHODS: Nasal symptom scores were recorded. Peripheral M2 macrophages were investigated according to cell surface markers, and M2-associated cytokine/chemokine release in serum and nasal secretion were assessed. In vitro pollen stimulation tests were performed, and polarized macrophage subsets were analyzed by flow cytometry. RESULTS: Compared to baseline, the percentage of peripheral CD163+ M2 macrophages in CD14+ monocytes increased during the pollen season (p < 0.001) and at the end of treatment (p = 0.004) in the SLIT group. The percentage of CD206+CD86- M2 cells in M2 macrophages during the pollen season was higher than that at baseline and at the end of SLIT. On the other hand, the percentage of CD206-CD86+ M2 cells in M2 macrophages significantly increased at the end of treatment in the SLIT group compared to baseline (p = 0.049), the peak pollen period (p = 0.017), and the placebo group (p = 0.0023). M2-associated chemokines CCL26 and YKL-40 were significantly increased during the pollen season in the SLIT group and remained higher at the end of SLIT than at baseline. Correspondingly, in vitro study demonstrated that Artemisia annua promoted M2 macrophage polarization in pollen-induced AR patients. CONCLUSION: Significant M2 macrophage polarization was promoted when patients with SAR were exposed to the allergen, either naturally exposed in pollen seasons or subjectively continuously exposed during the course of SLIT.

The use of specific immunoglobulin E in nasal secretions for the diagnosis of allergic rhinitis.

OBJECTIVE: Although local specific immunoglobulin (sIgE) has been employed as a diagnostic criterion for allergic rhinitis (AR), the use of local sIgE has not been fully evaluated in the diagnosis of allergic rhinitis. The aim of this study was to evaluate the use of nasal secretion sIgE in the diagnosis of allergic rhinitis. METHODS: A total of 51 patients (27 males and 24 females, mean age = 33.3 years) with rhinitis symptoms were enrolled consecutively from the allergy-rhinology clinic of Beijing TongRen Hospital (Beijing, People's Republic of China). Questionnaires were completed by each participant at recruitment to record demographic data, nasal symptom severity, and physician-diagnosed comorbid asthma. The severity of nasal obstruction, rhinorrhea, sneezing, and nasal/eye itching was recorded according to a visual analogue scale (VAS) of 10 cm. Sensitization to Dermatophagoides pteronyssinus, Dermatophagoides farinae, mugwort, Candida albicans, Penicillium notatum, Alternaria, Cladosporium, and Aspergillus were assessed according to presence of sIgE antibodies to these allergens in serum and nasal secretions. RESULTS: VAS scores of the participants ranged from 11 to 25 (mean = 17), and 14 (27.5%) patients had comorbid asthma. Based on serum sIgE, 31 (60.8%) patients were allergic to mugwort, 14 (27.5%) to Dermatophagoides, and three (5.9%) to fungal allergens. Based on nasal secretion sIgE, 32 (62.7%) patients were allergic to mugwort, 12 (23.5%) to Dermatophagoides, and three (5.9%) to fungal allergens. The local mugwort sIgE level and serum mugwort sIgE level were positively correlated with each other and with VAS scores. CONCLUSION: sIgE level in nasal secretions of subjects with rhinitis is a reliable noninvasive alternative to serum sIgE for diagnosis of allergic rhinitis. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:E311-E315, 2018.

Sphenopalatine Ganglion Acupuncture Improves Nasal Ventilation and Modulates Autonomic Nervous Activity in Healthy Volunteers: A Randomized Controlled Study.

The study aimed to assess the effects of Sphenopalatine ganglion (SPG) acupuncture on nasal ventilation function and autonomic nervous system in health volunteers. 39 healthy subjects were randomly assigned to either active SPG acupuncture group (AA group) or sham-SPG acupuncture group (SA group). All subjects were assessed for self-reported nasal ventilation, nasal patency (nasal airway resistance (NAR) and nasal cavity volume (NCV), exhaled nasal nitric oxide (nNO), and neuropeptides (substance P(SP), vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY)) in nasal secretions at baseline, 30 minutes, 2 hours, and 24 hours after acupuncture. Significantly more subjects in AA group reported improvements in nasal ventilation at all time points after acupuncture, compared to SA group. NAR and NCV were also significantly lower in AA group than SA group. The level of nNO in AA group was significantly decreased after 24 hours compared to SA group. The level of NPY was significantly increased in AA group at 30 minutes and 2 hours compared to baseline and SA group. The levels of SP and VIP were not significantly different in the two groups. We concluded that SPG acupuncture could help to improve nasal ventilation by increasing sympathetic nerve excitability in healthy volunteers.

[Prevalence of sensitization to aeroallergens in Beijing patients with allergic rhinitis].

OBJECTIVES: The purpose of this study was to determine which aeroallergens were prevalent in patients with allergic rhinitis in Beijing. METHOD: A total of 554 cases (female: 212, male: 342, aged between 4-69 years) who were diagnosed with allergic rhinitis by history and clinical presentation, underwent a skin prick test with 20 standardized aeroallergens, and the important sensitizing allergens were assessed. The samples were stratified on two age groups: 4-18-year-olds (children group, n = 81) and 19-60-year-olds (adults group, n = 401). Difference of SPT responses of the two groups was investigated. RESULT: The percent of patients with positive skin tests were follow:D. farinae (64.6%), D. pteronyssinus (64.3%), Flowers pollen (28.7%), Herbs (26.5%), Lamb's Quarters (13.7%) ,Tree II (13.5%), Giant Ragweed (12.5%). Tree I (12.5%) There were significantly higher sensitivity to dust mite among children group compared to adults group (P < 0.01). CONCLUSION: The study shows that the dust mite, Flowers pollen and Herbs are the most important three aeroallergens in Beijing region.