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      EUFOREA consensus on biologics for CRSwNP with or without asthma

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          Abstract

          Novel therapies such as type 2 targeting biologics are emerging treatment options for patients with chronic inflammatory respiratory diseases, fulfilling the needs of severely uncontrolled patients. The majority of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and over half of patients with asthma show a type 2 inflammatory signature in sinonasal mucosa and/or lungs. Importantly, both chronic respiratory diseases are frequent comorbidities, ensuring alleviation of both upper and lower airway pathology by systemic biological therapy. Type 2‐targeting biologics such as anti‐IgE, anti‐IL4Rα, anti‐IL5, and anti‐IL5Rα have entered the market for selected pheno/endotypes of asthma patients and may soon also become available for CRSwNP patients. Given the high prevalence of chronic respiratory diseases and the high cost associated with biologics, patient selection is crucial in order to implement such therapies into chronic respiratory disease care pathways.

          The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) organized a multidisciplinary Expert Board Meeting to discuss the positioning of biologics into the care pathways for CRSwNP patients with and without comorbid asthma.

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          Most cited references63

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          European Position Paper on Rhinosinusitis and Nasal Polyps 2012.

          The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007.The document contains chapters on definitions and classification, we now also proposed definitions for difficult to treat rhinosinusitis, control of disease and better definitions for rhinosinusitis in children. More emphasis is placed on the diagnosis and treatment of acute rhinosinusitis. Throughout the document the terms chronic rhinosinusitis without nasal polyps and chronic rhinosinusitis with nasal polyps are used to further point out differences in pathophysiology and treatment of these two entities. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. Last but not least all available evidence for management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is analyzed and presented and management schemes based on the evidence are proposed.
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            Effect of Subcutaneous Dupilumab on Nasal Polyp Burden in Patients With Chronic Sinusitis and Nasal Polyposis: A Randomized Clinical Trial.

            Dupilumab has demonstrated efficacy in patients with asthma and atopic dermatitis, which are both type 2 helper T-cell-mediated diseases.
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              Clinical and inflammatory characteristics of the European U-BIOPRED adult severe asthma cohort.

              U-BIOPRED is a European Union consortium of 20 academic institutions, 11 pharmaceutical companies and six patient organisations with the objective of improving the understanding of asthma disease mechanisms using a systems biology approach.This cross-sectional assessment of adults with severe asthma, mild/moderate asthma and healthy controls from 11 European countries consisted of analyses of patient-reported outcomes, lung function, blood and airway inflammatory measurements.Patients with severe asthma (nonsmokers, n=311; smokers/ex-smokers, n=110) had more symptoms and exacerbations compared to patients with mild/moderate disease (n=88) (2.5 exacerbations versus 0.4 in the preceding 12 months; p<0.001), with worse quality of life, and higher levels of anxiety and depression. They also had a higher incidence of nasal polyps and gastro-oesophageal reflux with lower lung function. Sputum eosinophil count was higher in severe asthma compared to mild/moderate asthma (median count 2.99% versus 1.05%; p=0.004) despite treatment with higher doses of inhaled and/or oral corticosteroids.Consistent with other severe asthma cohorts, U-BIOPRED is characterised by poor symptom control, increased comorbidity and airway inflammation, despite high levels of treatment. It is well suited to identify asthma phenotypes using the array of "omic" datasets that are at the core of this systems medicine approach.
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                Author and article information

                Contributors
                w.j.fokkens@amc.nl
                Journal
                Allergy
                Allergy
                10.1111/(ISSN)1398-9995
                ALL
                Allergy
                John Wiley and Sons Inc. (Hoboken )
                0105-4538
                1398-9995
                15 July 2019
                December 2019
                : 74
                : 12 ( doiID: 10.1111/all.v74.12 )
                : 2312-2319
                Affiliations
                [ 1 ] Department of Otorhinolaryngology Amsterdam University Medical Centres, Location AMC Amsterdam Amsterdam The Netherlands
                [ 2 ] European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) Brussels Belgium
                [ 3 ] Royal National Throat, Nose and Ear Hospital University College London Hospitals London UK
                [ 4 ] Upper Airways Research Laboratory University of Ghent Gent Belgium
                [ 5 ] Division of ENT Diseases, CLINTEC Karolinska Institute, and Department of ENT Diseases Karolinska University Hospital Stockholm Sweden
                [ 6 ] Department of Otorhinolaryngology, Hospital Clínic Universitat de Barcelona, IDIBAPS, CIBERES Barcelona, Catalonia Spain
                [ 7 ] Department of Respiratory Medicine and Allergology Lund University Lund Sweden
                [ 8 ] Department of Respiratory Disease University Hospital Arnaud de Villeneuve Montpellier France
                [ 9 ] Personalized Medicine, Asthma & Allergy - Humanitas Clinical and Research Center IRCCS Rozzano (MI) Italy
                [ 10 ] Department of Biomedical Science Humanitas University Pieve Emanuele (MI) Italy
                [ 11 ] Division of Otolaryngology‐Head & Neck Surgery University of Montreal Hospital Centre (CHUM) Montreal Quebec Canada
                [ 12 ] Department of Clinical Pharmacy & Pharmacology and Department of General Practice UMCG, and QPS‐NL Groningen The Netherlands
                [ 13 ] Department of Respiratory Medicine, First Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic
                [ 14 ] Department of Otolaryngology, Head & Neck Surgery Eastern Virginia Medical School Norfolk Virginia
                [ 15 ] Guy’s and St. Thomas’ NHS Foundation Trust London UK
                [ 16 ] ENT Department University Hospital of Nancy, Brabois-ILM Nancy France
                [ 17 ] Department of Respiratory Medicine Ghent University Hospital Gent Belgium
                [ 18 ] Opuscomms London UK
                [ 19 ] Rhinology & Endoscopic Skull Base Surgery UCLA Department of Head & Neck Surgery Los Angeles California
                [ 20 ] Division of Sinonasal Disorders and Allergy, Department of Otolaryngology—Head & Neck Surgery University of Pittsburgh School of Medicine Pittsburgh Pennsylvania, USA
                [ 21 ] Department of Microbiology, Immunology and Transplantation Allergy and Clinical Immunology Research Group Leuven Belgium
                [ 22 ] Division of Rhinology, Allergy, and Endoscopic Skull Base Surgery University of North Carolina at Chapel Hill Chapel Hill North Carolina
                [ 23 ] Department of Otorhinolaryngology‐Head and Neck Surgery University Hospitals Leuven Leuven Belgium
                Author notes
                [*] [* ] Correspondence

                Wytske J. Fokkens, Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Meibergdreef 9, 1100AD, Amsterdam, The Netherlands.

                Email: w.j.fokkens@ 123456amc.nl

                Author information
                https://orcid.org/0000-0003-4852-229X
                https://orcid.org/0000-0003-4742-1665
                https://orcid.org/0000-0003-3463-5007
                https://orcid.org/0000-0002-0492-5663
                https://orcid.org/0000-0002-4399-9892
                Article
                ALL13875
                10.1111/all.13875
                6972984
                31090937
                e580e303-ffc3-4908-8f14-d1a45af9e3c0
                © 2019 The Authors Allergy Published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 06 March 2019
                : 11 April 2019
                : 14 April 2019
                Page count
                Figures: 2, Tables: 0, Pages: 8, Words: 5842
                Categories
                Review
                Reviews
                Custom metadata
                2.0
                December 2019
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.5 mode:remove_FC converted:21.01.2020

                Immunology
                asthma,biologics,chronic rhinosinusitis,nasal polyps,type 2 inflammation
                Immunology
                asthma, biologics, chronic rhinosinusitis, nasal polyps, type 2 inflammation

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