2018 Section 5 - Rhinology and Allergic Disorders

B. Phenotypes/Endotypes i. Microbiome

Lal D, Keim P, Delisle J, et al. Mapping and comparing bacterial microbiota in the sinonasal cavity of healthy, allergic rhinitis, and chronic rhinosinusitis subjects. Int Forum Allergy Rhinol . 2017; 7(6):561- 569. EBM level 3....................................................................................................................................52-60 Summary : This study compared the regional microbiome between the middle and inferior meatus. The authors found that differences between patients in both sites was greater than within the same patient in terms of composition, taxon presence, and abundance. Unlike healthy controls and allergic rhinitis and CRSwNP patients, patients with CRSsNP demonstrated decreased diversity and increased anaerobes in the middle meatus relative to the inferior meatus. In contrast, CRSwNP patients were enriched in Staphylococcus or Alloiococcus , consistent with previous culture-based findings. These findings reinforce evidence for microbial involvement in CRS subtypes. Tomassen P, Vandeplas G, Van Zele T, et al. Inflammatory endotypes of chronic rhinosinusitis based on cluster analysis of biomarkers. J Allergy Clin Immunol . 2016; 137(5):1449-1456. EBM level 2.......................................................................................................................................................61-72 Summary : This was a multicenter case-control study. Surgical tissue of CRS and control subjects was analyzed for IL-5, IFN-γ, IL-17A, TNF-α, IL-22, IL-1β, IL-6, IL-8, eosinophilic cationic protein, myeloperoxidase, TGF-β1, IgE, Staphylococcus aureus enterotoxin–specific IgE, and albumin. Distinct CRS clusters with diverse inflammatory mechanisms largely correlated with CRS phenotypes. The authors believe that the cluster of inflammatory cytokines associated with a CRS phenotype further differentiated them and provided a more accurate description of the inflammatory mechanisms involved. Allergic fungal rhinosinusitis (AFRS) Gan EC, Thamboo A, Rudmik L, et al. Medical management of allergic fungal rhinosinusitis following endoscopic sinus surgery: an evidence-based review and recommendations. Int Forum Allergy Rhinol . 2014; 4(9):702-715. EBM level 3a.........................................................................................................73-86 Summary : This article reviews the evidence for the treatment AFRS after endoscopic sinus surgery. The available evidence supports the use of systemic and topical nasal corticosteroids, while nonstandard topical nasal corticosteroids, oral antifungals, and immunotherapy are options for refractory AFRS. Lu-Myers Y, Deal AM, Miller JD, et al. Comparison of socioeconomic and demographic factors in patients with chronic rhinosinusitis and allergic fungal rhinosinusitis. Otolaryngol Head Neck Surg . 2015; 153(1):137-143. EBM level 2b.....................................................................................................87-93 Summary : This article contrasts two endotypes of chronic rhinosinusitis: CRS and AFRS. The authors found that patients with CRS tend to have higher incomes, have more access to primary care, are older at time of diagnosis, and have lower Lund-MacKay scores and total IgE than those with AFRS. Masterson L, Egro FM, Bewick J, et al. Quality-of-life outcomes after sinus surgery in allergic fungal rhinosinusitis versus nonfungal chronic rhinosinusitis. Am J Rhinol Allergy . 2016; 30(2):e30-e35. EBM level 4.......................................................................................................................................................94-99 Summary : This article contrasts quality-of-life (QOL) outcomes in patients with AFRS to those with CRS. The authors report significantly greater improvements in QOL scores for patients with AFRS at 9 and 12 months postoperatively compared to those with CRS without nasal polyps.

ii.