xRead - Nasal Obstruction (September 2024) Full Articles

20426984, 2021, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.22741 by Stanford University, Wiley Online Library on [01/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

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Orlandi et al.

(PPV 85.15%), diffuse (PPV 91.7%) and polypoid edema (PPV 88.9%) – the highest grades of MT edema – had the strongest association with allergy. Using multifocal MT edema as a cutoff, sensitivity (94.7%) and specificity (23.4%) for association with inhalant allergy were determined by receiver-operator (ROC) analysis. A comparison of traditional paranasal sinus polyposis to MT polyposis was published in 2017 by Brunner et al. 3 In this report, the authors describe significant dif ferences between patients with diffuse paranasal sinus polyposis and polyps/polypoid edema originating on the MT. In this analysis, traditional paranasal sinus polyposis patients were more commonly older, male, had CRS, and had higher L-M and NOSE scores. MT polypoid change patients were more commonly younger, female, had AR, and had lower L-M score. In 2017, DelGaudio et al. introduced the term “central compartment atopic disease” to describe an entity asso ciated with MT polypoid edema and atopy that has pro gressed to involve additional central nasal cavity structures (superior turbinate, posterior nasal septum). CCAD typi cally also involves the sinus cavities in a medial to lateral progression, sparing the lateral and superior sinus surfaces such as the ethmoid/sphenoid roof, lamina papyracea, and lateral aspect of the maxillary sinuses. In the introductory multi-institutional case series, CCAD was associated with symptomatic allergy in all patients and allergen sensitiv ity on testing in 93.3%. It has also been demonstrated that CCAD may coexist with other sinus inflammatory pro cesses and pathologic findings such as AERD 5 and respi ratory epithelioid adenomatous hamartoma 6 (REAH). In comparison to other subtypes of CRSwNP, CCAD (whether isolated or associated with diffuse paranasal sinus poly posis) demonstrates significantly higher association with allergy ( p < 0.001) than CRSwNP not-otherwise-specified. Two studies have evaluated the radiologic characteristics of CCAD with the aim of identifying CT scan findings that point to possible allergic contribution in CRS. Hamizan et al. evaluated CT scans of 112 patients (224 sides), not ing centrally limited disease was associated with positive allergy testing ( p = 0.03, specificity 90.82%, PPV 73.53%). 8 Roland et al. evaluated CT scans from 356 patients, noting certain features – oblique MT orientation, septal involve ment and lower L-M score – are associated with CCAD. Based on literature published in recent years, EPOS2020 10 has included CCAD as a diagnostic cate gory under Type 2 endotypes of diffuse CRS. However, some controversy remains on this topic. In response to a 2020 CCAD editorial by DelGaudio, 11 Chandra 12 questions the true presence of polyps emanating from the MT (versus presence of a bulbous MT), points to the low ( < 5%) prevalence of polyps in AR patients, and notes that local allergic manifestations are features not unique to CCAD.

CCAD is a new concept, largely introduced since ICAR RS-2016. Early reports, primarily from a few centers, have supported an allergic etiology for CCAD. However addi tional work should be undertaken to further verify the CCAD concept and treatment responses. This includes evaluation of local allergic responses (antigen-specific IgE, nasal allergen challenge), histologic studies, endotyp ing of inflammatory processes, and evaluation of clinical outcomes (extent of surgery, pharmacotherapy, allergen immunotherapy).

Inhalant Allergy as a Contributing Factor for Central Compartment Atopic Disease Aggregate Grade of Evidence: C (Level 3: 1 study; level 4: 8 studies; Table X-6).

X.C.3 Contributing Factors for CRSwNP: Biofilms With regard to CRSwNP, biofilm presence and polyp sta tus seem to have at most a limited relationship. One study showed no association, 570 while another study showed a trend toward an increased number of bacte rial species in CRS with polyps. A more recent study demonstrated an association between biofilms and polyp status. 1401 Interestingly, fungi were only detected in the presence of NPs, although this was a rare finding. 577 In CRSwNP there was no qualitative difference in inflamma tory cells between patients with or without biofilms. 1402 Quantitatively, there is an association between biofilms and increased eosinophilic content, in accordance with other evidence that biofilms encourage a Th2 immune response. 729,1403 A possible explanation of this observa tion is the high prevalence of S. aureus as well as P. aeruginosa in CRS biofilms. 586,1404 S. aureus is associ ated with production of superantigen thereby driving a Th2 response 729 while pseudomonal quorum sensing molecules have been demonstrated to activate solitary chemosensory cells 609,1405 via canonical taste signaling pathways. 1406 Solitary chemosensory cells (SCCs) are rare ( < 2%) airway epithelial cells that have demonstrated their ability to regulate epithelial cell antimicrobial peptide secretion via taste receptor transduction. 1407 More recently, SCCs have been shown to be the exclusive epithelial source of the early Th2 cytokine IL-25, 1408–1410 which is elevated in CRSwNPs. 162,1411–1413 Additionally, SCCs have recently been demonstrated to be active producers of