The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, 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. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

/pdf/european-position-paper-on-rhinosinusitis-and-nasal-polyps-mj734vsl7p.pdf

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

Background To date, no study has evaluated the diversity of T H cell cytokine patterns of patients with chronic rhinosinusitis (CRS) among centers in different continents using identical methods. Objective We sought to assess T H cytokine profiles in patients with CRS from Europe, Asia, and Australia. Methods Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP; n = 435) and control subjects (n = 138) were recruited from centers in Adelaide, Benelux, Berlin, Beijing, Chengdu, and Tochigi. Nasal mucosal concentrations of T H 2, T H 17, and T H 1 cytokines; eosinophilic cationic protein (ECP); myeloperoxidase (MPO); IL-8; and tissue total and Staphylococcus aureus enterotoxin (SE)–specific IgE were measured by using identical tools. Results Combinations of T H 1/T H 2/T H 17 cytokine profiles in patients with CRSwNP varied considerably between regions. CRSwNP tissues from patients from Benelux, Berlin, Adelaide, and Tochigi were T H 2 biased, whereas those from Beijing mainly demonstrated T H 2/T H 1/T H 17 mixed patterns, and patients from Chengdu showed an even lower T H 2 expression. Concentrations of IL-8 and tissue total IgE in patients with CRSwNP were significantly higher than those in control subjects in all regions. More than 50% of patients with CRSwNP in Benelux, Berlin, Adelaide, and Tochigi showed a predominantly eosinophilic endotype compared with less than 30% of patients in Beijing and Chengdu. SE-specific IgE was found in significantly greater numbers in patients with CRSwNP from Benelux, Adelaide, and Tochigi and significantly lower numbers in patients from Beijing and Chengdu. Moreover, the T H 1/T H 2/T H 17 cytokine profiles in patients with CRSsNP showed diversity among the 6 regions. Conclusion T H cytokine levels, eosinophilic/neutrophilic patterns, and SE-specific IgE expressions show extreme diversity among patients with CRS from Europe, Asia, and Oceania.

https://biblio.ugent.be/publication/8506461/file/8506462.pdf

Diversity of TH cytokine profiles in patients with chronic rhinosinusitis: A multicenter study in Europe, Asia, and Oceania

I. Executive summary BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. Methods ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. Conclusion This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Chronic rhinosinusitis (CRS) affects more than 10% of the population in the United States and Europe. Recent findings point to a considerable variation of inflammatory subtypes in patients with CRS with nasal polyps and patients with CRS without nasal polyps. According to current guidelines, glucocorticosteroids and antibiotics are the principle pharmacotherapeutic approaches; however, they fail in a group of patients who share common clinical and laboratory markers. Several clinical phenotypes often leading to uncontrolled disease, including adult nasal polyposis, aspirin-exacerbated respiratory disease, and allergic fungal rhinosinusitis, are characterized by a common endotype: a TH2 bias is associated with a higher likelihood of comorbid asthma and recurrence after surgical treatment. As a consequence, several innovative approaches targeting the TH2 bias with humanized mAbs have been subjected to proof-of-concept studies in patients with CRS with nasal polyps with or without comorbid asthma: omalizumab, reslizumab, mepolizumab, and recently dupilumab. Future concepts using upstream targets, such as GATA-3, also focus on this endotype. This current development might result in advantages in the treatment of patients with the most severe CRS.

https://www.jacionline.org/article/S0091-6749(15)01511-0/pdf

Current and future treatment options for adult chronic rhinosinusitis: Focus on nasal polyposis

Background
The prevalence of allergic rhinitis (AR) has increased worldwide in recent decades. This study was conducted to investigate the prevalence of self‐reported AR and profiles of AR‐related comorbidities in the adult population of China over time.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/all.12874

An increased prevalence of self-reported allergic rhinitis in major Chinese cities from 2005 to 2011.

Chronic rhinosinusitis (CRS) is characterized by inflammation of the mucosa of the nose and paranasal sinuses with a duration of at least 12 consecutive weeks and is a common otorhinolaryngologic disease that is frequently encountered in everyday practice (1). Although CRS is not a life-threatening disease, not all patients are cured or achieve control of their symptoms, even with maximal medical management or surgical intervention. The symptoms in CRS patients with (CRSwNP) and without nasal polyps (CRSsNP) are considerably overlapping, while patients with CRSwNP have higher symptom scores and more nasal symptoms (2). Patients with CRSwNP are particularly recalcitrant to usual therapies, and this type of CRS is increasingly prevalent (3). The persistent symptoms can result in facial pain/headache, impairments in general health, vitality and social functioning, stress disorders and other problems that affect patients’ lives and work (4–7).

The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) group proposed clear guidelines for a symptom-based definition of rhinosinusitis that has been validated and accepted in epidemiological studies (1,8,9). The European postal survey of 57 128 adults in 12 countries reported that the overall prevalence of EP3OS-defined CRS was 10.9% and ranged from 6.9% to 27.1% in 19 centres (10). A recent survey reported a prevalence of EP3OS-defined CRS of 5.51% in Sao Paulo, Brazil (11). Some authors have used the data from the National Population Health Survey to estimate the prevalence of CRS and found prevalences of 6.95% in Korea (12) and 5.7% among female and 3.4% among male Canadians (13). The 2012 National Health Interview Survey of 34 525 adults found that 12% of adults have been told by a doctor or other health professional that they have sinusitis, and these self-reported doctor-diagnosed prevalences of sinusitis were 15% and 9% among males and females, respectively. The vital health statistic data revealed that CRS is more prevalent than other common chronic respiratory diseases, such as chronic obstructive pulmonary disease (3%) and asthma (8%) (14). Based on this high prevalence, some studies in the USA have claimed that CRS poses an enormous health and economic burden to individuals, the community and society (15). When accounting for the entire population into account, the health burden of CRS is speculated to be huge in Asia; nevertheless, little is known about the actual situation.

A survey of 4554 Danes reported a CRS prevalence of 7.8% compared to the overall prevalence of 10.9% in 19 European centres (10,16). The National Health Interview Survey of US adults revealed a decreasing trend in CRS from 16% in 1997 to 14% in 2006 and 12% in 2012 (14,17,18). The literature suggests that the prevalence and patterns of CRS might vary by region and population and change over time due to environmental changes and the development of health care. The previous epidemiological data regarding CRS are mainly from western studies, and little is known regarding the potential socio-economic disparities. In Asia, large-scale epidemiological studies are required to update information about the prevalence of CRS, and such studies would provide information for the assessment of the disease burden and the development and promotion of public health policies associated with CRS.

We conducted a cross-sectional investigation in seven major Chinese cities. This study aimed to provide a better understanding of the epidemiological characteristics of CRS, including its prevalence and associations with socio-economic factors and tobacco smoke.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/all.12577

P. Z. Li

Papers

Epidemiology of chronic rhinosinusitis: results from a cross-sectional survey in seven Chinese cities.