• Rhinosinusitis consensus

• Humans
• Air Pollution/adverse effects
• Rhinitis, Allergic/epidemiology
• Rhinitis, Allergic/diagnosis
• Prevalence
• Sinusitis/epidemiology
• Sinusitis/diagnosis
• Asthma/epidemiology
• Asthma/diagnosis
• Air Pollutants/adverse effects
• Risk Factors
• Risk Assessment
• Environmental Exposure/adverse effects
• Particulate Matter/adverse effects

• Allergic
• Asthma
• Atopic
• Dermatitis
• Genetic predisposition to disease
• Nasal polyps
• Rhinitis

• Mendelian randomization
• chronic obstructive pulmonary disease
• chronic respiratory diseases
• chronic rhinitis
• pediatric asthma
• united airways disease

• classification and taxonomy
• asthma

• Humans
• Asthma/epidemiology
• Asthma/genetics
• Genome-Wide Association Study
• Phenotype
• Comorbidity
• Japan/epidemiology

• R01 MH107666 NIMH NIH HHS
• S10 RR025141 NCRR NIH HHS
• UH3 OD023282 NIH HHS
• U19 AI095230 NIAID NIH HHS
• U01 HL108634 NHLBI NIH HHS
• U19 AI162310 NIAID NIH HHS
• R01 HD074711 NICHD NIH HHS
• P50 GM115305 NIGMS NIH HHS
• UL1 TR002389 NCATS NIH HHS
• U01 HG009086 NHGRI NIH HHS
• R01 MH113362 NIMH NIH HHS
• P30 DK020595 NIDDK NIH HHS
• MC_QA137853 Medical Research Council
• R01 HL122712 NHLBI NIH HHS
• S10 OD017985 NIH HHS
• MC_PC_17228 Medical Research Council
• UL1 TR000445 NCATS NIH HHS
• U19 HL065962 NHLBI NIH HHS
• R01 HL129735 NHLBI NIH HHS
• R01 HL104608 NHLBI NIH HHS
• RC2 GM092618 NIGMS NIH HHS
• UG3 OD023282 ODCDC CDC HHS
• UG3 OD023282 NIH HHS
• K08 HL153955 NHLBI NIH HHS
• U01 HG006378 NHGRI NIH HHS
• UL1 RR024975 NCRR NIH HHS
• R01 NS032830 NINDS NIH HHS
• U01 HG004798 NHGRI NIH HHS
• UL1 TR002243 NCATS NIH HHS
• U.S. Department of Health & Human Services | NIH | National Institute of Mental Health (NIMH)
• U.S. Department of Health & Human Services | NIH | National Institute of Diabetes and Digestive and Kidney Diseases (National Institute of Diabetes & Digestive & Kidney Diseases)
• U.S. Department of Health & Human Services | NIH | National Heart, Lung, and Blood Institute (NHLBI)
• U.S. Department of Health & Human Services | NIH | National Institute of Allergy and Infectious Diseases (NIAID)
• U.S. Department of Health & Human Services | NIH | NIH Office of the Director (OD)
• United States Department of Defense | Defense Advanced Research Projects Agency (DARPA)
• Gift from Liz and Kent Dauten
• U.S. Department of Health & Human Services | NIH | National Center for Advancing Translational Sciences (NCATS)
• Rafael Rivera III Memorial Foundation for Asthma Research

• S. aureus biofilm/virulence factor
• chronic rhinosinusitis
• inflammatory cells/endotypes

• Allergic rhinitis
• Eicosanoids
• Interleukins
• Light-emitting diode
• Local photobiomodulation
• Mast cells

• Pseudomonas aeruginosa
• asthma
• chronic rhinosinusitis
• exoproteins
• mucosal barrier

Chronic rhinosinusitis (CRS) has a high prevalence of anxiety and depression. It is currently uncertain if treatment in patients with CRS with or without nasal polyps (CRSwNP and CRSsNP) has any impact on improving mental health outcomes. The aims here were to document anxiety and depression in patients with severe CRS and asthma already treated with appropriate medical therapy. We then evaluated whether further maximal treatment with omalizumab improved anxiety and/or depression alongside improvements in CRS and coassociated asthma.

Hospital Anxiety and Depression Scale (HADS) scores along with measures of CRS and asthma severity were recorded according to CRSwNP and CRSsNP status in n = 95 patients with severe CRS and asthma. Of this group, a further n = 23 had omalizumab for associated allergic asthma. Follow‐up measures were collected 16 weeks after omalizumab treatment.

HADS anxiety and depression prevalence in CRS were 49.47 % and 38.95%, respectively. Within the CRSwNP and CRSsNP group 53.06% and 45.66% had raised HADS‐anxiety scores. Abnormal HADS‐depression scores were present in 40.82% and 36.95% of the CRSwNP and CRSsNP groups, respectively. Correlations for sinonasal outcome test‐22 (SNOT‐22) versus HADS total was r = 0.59 p < 0.0001, HADS‐anxiety r = 0.56 p < 0.0001 and HADS‐depression r = 0.49 p < 0.0001. Omalizumab improved anxiety in CRS (p < 0.0001) regardless of nasal polyp status (CRSwNP p = 0.0042 and CRSsNP p = 0.0078). Depression scores did not improve in either group. SNOT‐22 (p = 0.0006), asthma control questionnaire‐7 (p = 0.0019) and mini‐asthma quality of life questionnaire including emotional function (p = 0.0003 and p = 0.0009, respectively) all improved in both subgroups.

In CRS and asthma, anxiety scores but not depression improved after omalizumab treatment. Anxiety may be closely related to airway disease severity, but depression may be independent of airway disease itself. If so, a separate mental health care pathway is needed for CRS patients with depression.

• anxiety
• asthma
• depression
• omalizumab
• rhinosinusitis

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex, clinically heterogeneous and persistent inflammatory disorder of the upper airway. Detailed mechanistic insights into disease pathogenesis are lacking, but it is now accepted that local tissue IgE driven T2-high inflammatory pathways are critical to disease. The recent CRSwNP Phase 3 POLYP1 and POLYP2 replicate studies of blocking IgE with omalizumab confirmed rapid improvements in all clinical parameters of sinonasal disease, confirming a pivotal role for IgE driven inflammatory pathways in CRSwNP. This review summarises the biology of IgE in relation to CRSwNP. Insight into how IgE may drive CRSwNP is evaluated in the context of clinical improvements seen with omalizumab. The need for further studies using a broader patient and biomarker specific groups to aid more precise drug-patient selection alongside more detailed mechanistic studies of omalizumab in CRSwNP is highlighted.

• IgE
• nasal polyps
• omalizumab
• rhinosinusitis

• Dupilumab
• IL-13
• IL-4
• IL-4Rα
• inflammation
• nasal polyps
• rhinosinusitis

The aim of this study was to evaluate an epidemiologic association of asthma and chronic rhinosinusitis (CRS) using a national sample cohort of the Korean population. We collected data from the Korean Health Insurance Review and Assessment Service-National Sample Cohort between 2002 and 2013, and two different case-control cohorts were designed (1st: asthmatic patients matched in a 1:1 ratio with 204,119 non-asthmatics as control I, 2nd: CRS patients matched in a 1:4 ratio with 124,020 non-CRS patients as control II). Bidirectional association was examined using Cox proportional hazard models stratified by age, sex, income, and region of residence. Patients with asthma had an increased risk of developing CRS [adjusted hazard ratio (95% confidence interval) = 1.74 (1.67–1.80)], both with nasal polyps [1.55 (1.36–1.78)], without nasal polyps [1.74 (1.67–1.81)]. In the second cohort, patients with CRS had increased risk of developing asthma [1.85 (1.80–1.91)] with similar results for those with and without nasal polyps. The strongest association for risk of CRS was in 20–39 years old men with asthma [2.41 (1.97–2.96)], while the strongest association for increased risk of asthma in those with CRS group was also seen in this same subgroup [2.40 (2.18–2.63)]. CRS and asthma had a bidirectional influence on each other. CRS increased the risk of asthma, and asthma increased the risk of CRS, especially in young men.

In September 2019, The Lancet published details of two large Phase III double-blind placebo-controlled studies (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52) confirming the clinical efficacy of the biologic dupilumab in simultaneously blocking both IL-4/IL-13 signalling in chronic rhinosinusitis with nasal polyps (CRSwNP). The studies demonstrated that dupilumab (Dupixent^®, Sanofi and Regeneron) 300mg subcutaneously administered was clinically effective when added for patients with moderate to severe CRSwNP already maintained on the standard intranasal steroid mometasone furoate. Duration of treatment ranged from injections either 2 weekly for 24 weeks (SINUS-24) or every 2 weeks for 52 weeks or finally every 2 weeks for 24 weeks stepping down thereafter to every 4 weeks for a further 28 weeks (SINUS-52). Rapid improvements in all important parameters of disease burden were seen with such improvement maintained even where the frequency of injections was decreased. In patients with co-existent asthma, lung function and asthma control scores improved. This is consistent with the one airway hypothesis of shared T2 inflammatory programmes driving both disease syndromes. The studies formed the basis for FDA registration and clinical launch in the US, and EMA approval in Europe. Dupilumab presents a significant new treatment option in an area of urgent unmet therapeutic need in CRSwNP. Should dupilumab prove to be as effective in the real-life clinical environment as it has been in the studies, then a paradigm shift from sinonasal surgery to medical treatment of CRSwNP may need to occur in the ENT community. Questions in relation to best patient selection, combined upper and lower airway therapeutic pathways, long-term safety along with health economics and cost constraints ought now to be addressed.

• biologic
• inflammation
• monoclonal antibody
• sinusitis
• therapeutics

• functional outcomes
• pediatric allergic airway disease
• pediatric allergic asthma
• pediatric allergic rhinitis
• pediatric respiratory atopy

• Asthma
• TGF-β superfamily
• chronic rhinosinusitis
• immune dysregulation
• immunopathogenesis
• inflammation
• remodeling

Allergic airway diseases (AADs) are a group of heterogeneous disease mediated by T-helper type 2 (Th2) immune response and characterized with airway inflammation and remodeling, including allergic asthma, allergic rhinitis, and chronic rhinosinusitis with allergic background. This review aimed to discuss the abnormal epithelial-mesenchymal crosstalk in the pathogenesis of AADs.

Articles referred in this review were collected from the database of PubMed published in English up to January 2018.

We had done a literature search using the following terms “allergic airway disease OR asthma OR allergic rhinitis OR chronic sinusitis AND IL-25 OR IL-33 OR thymic stromal lymphopoietin OR fibrocyte”. Related original or review articles were included and carefully analyzed.

It is now believed that abnormal epithelial-mesenchymal crosstalk underlies the pathogenesis of AADs. However, the key regulatory factors and molecular events involved in this process still remain unclear. Epithelium-derived triple cytokines, including interleukin (IL)-25, IL-33, and thymic stromal lymphopoietin (TSLP), are shown to act on various target cells and promote the Th2 immune response. Circulating fibrocyte is an important mesenchymal cell that can mediate tissue remodeling. We previously found that IL-25-circulating fibrocyte axis was significantly upregulated in patients with asthma, which may greatly contribute to asthmatic airway inflammation and remodeling.

In view of the redundancy of cytokines and “united airway” theory, we propose a new concept that IL-25/IL-33/TSLP-fibrocyte axis may play a vital role in the abnormal epithelial-mesenchymal crosstalk in some endotypes of AADs. This novel idea will guide potential new intervention schema for the common treatment of AADs sharing common pathogenesis in the future.

• Allergic Airway Diseases
• Axis
• Crosstalk
• Fibrocyte
• Interleukin-25/Interleukin-33/Thymic Stromal Lymphopoietin

• Asthma
• Extracellular vesicle
• Metagenomic analysis
• Microbiota
• Rhinitis

• Biologics
• biomarkers immunology
• nasal polyps
• rhinosinusitis

• WGCNA
• allergic asthma
• gene expression

• Biomarker
• Molecular diagnostics
• Molecular therapy
• Pediatric otolaryngology
• miRNA
• microRNA

• Allergy
• Aspirin sensitivity
• Asthma
• Epidemiology
• Quality of life
• Rhinitis
• Rhinosinusitis
• Sinusitis

• airway
• asthma
• remodelling
• rhinitis
• rhinosinusitis

Facial candling is one of the traditional treatments that is claimed to be able to help in curing or reducing various allergy and inflammation conditions such as allergic rhinitis. We aimed to explore the perceptions of participants with allergic rhinitis toward their disease conditions and facial candling treatment.

The study used a qualitative exploratory design, comprising 12 in-depth interviews. A semi-structured topic guide was used to explore all relevant aspects of the topic, which were audio recorded, transcribed verbatim. All the interviews were conducted in a few beauty salons in purposively selected city areas in the state of Kedah, Malaysia.

Of the 12 patients, seven (58%) reported a positive experience of facial candling treatment, with improvement in the condition of their allergic rhinitis. Specific themes about the experience of facial candling treatment that were identified within the transcript data included knowledge about facial candling, options for disease treatment, effectiveness of facial candling, sources of information, comparison, application of treatment, treatment budget, and safety. The major strength lies in the fact that reasons for using facial candling were uncovered from the perspectives of people with allergic rhinitis through the in-depth interviews.

The motives of these participants for using facial candling are mainly due to cultural influence and its low cost of treatment. There were mixed responses from the participants about the usefulness of facial candling. Most of the respondents had not assessed the safety of prolonged use of facial candling and regarded it as a safe procedure as this has been practiced for generations.

• Complementary medicine
• ear nose and throat
• face candling
• inflammation
• nasal blockage
• otolaryngology
• traditional medicine

Up to 80% of asthmatic children may experience upper airway symptoms which are often perceived as coming from the lower airways. Currently, there are no validated questionnaires to assess upper airway contribution to pediatric asthma symptoms. The Sino-Nasal 5 (SN-5) questionnaire was previously validated for identifying radiographic confirmed sinus disease in children. In this study, we hypothesize that significant SN-5 scores (≥3.5) are associated with abnormal National Asthma Education and Prevention Program (NAEPP) based asthma impairment and control in asthmatic children. Retrospective data collected on children with asthma referred for pulmonary evaluation included age, gender, ethnicity, NAEPP asthma severity, asthma control (Test for Respiratory and Asthma Control in Kids (TRACK) < 5 years, Asthma Control Test (ACT) 5 years) and pulmonary function testing. Associations between SN-5 scores and asthma impairment and control were identified. Seventy-six children were evaluated; 38% were female with a mean age of 6.9 years. Significant SN-5 scores were associated with decreased control of daytime symptoms (odds ratio (OR): 0.16 (95% confidence interval (CI): 0.06–0.44)), night time awakenings (0.09 (0.03–0.29)), activity interference (0.2 (0.06–0.68)), NAEPP defined asthma control (0.32 (0.12–0.85)) and poor asthma control based on TRACK (p < 0.001) and ACT (p < 0.001). This suggests upper airways may play a larger role in perceived lower airway symptoms, and SN-5 may be beneficial in assessing the contribution of upper airway conditions on asthma control.

• Sino-Nasal 5 score
• asthma
• rhinosinusitis
• screening

• AGE
• Advanced glycation end products
• Coronary heart disease
• Excess free fructose
• Fructose
• Fructose glucose ratio
• Fructose malabsorption
• Fructositis
• HFCS
• Heart disease
• High fructose corn syrup
• Isoglucose
• RAGE
• SSB
• Sugar sweetened beverages
• enFruAGE

• Allergy
• asthma
• eczema
• rhinitis

• airway
• allergy
• asthma
• chronic rhinitis
• chronic rhinosinusitis

• Asthma/diagnosis
• Asthma/drug therapy
• Asthma/epidemiology
• Asthma/physiopathology
• Cross-Sectional Studies
• Endoscopy
• Female
• Humans
• Male
• Middle Aged
• Paranasal Sinuses/diagnostic imaging
• Prospective Studies
• Rhinitis/diagnosis
• Rhinitis/drug therapy
• Rhinitis/epidemiology
• Rhinitis/physiopathology
• Severity of Illness Index
• Sinusitis/diagnosis
• Sinusitis/drug therapy
• Sinusitis/epidemiology
• Sinusitis/physiopathology
• Tomography, X-Ray Computed
• Treatment Outcome

• 16S ribosomal RNA
• Asthma
• T(H)2 inflammation
• atopy
• bacteria
• corticosteroids
• metabolic pathways
• microbiome
• short-chain fatty acids
• three-gene mean

• ARIA
• Classification
• Lung function test
• Rhinitis
• Spirometry

The concept of united airway diseases (UAD) has received increasing attention in recent years. Sustained and increased inflammation is a common feature of UAD, which is inevitably accompanied with marked gene modification and tight gene regulation. However, gene regulation in the common inflammatory processes in UAD remains unclear. MicroRNA (miRNA), a novel regulator of gene expression, has been considered to be involved in many inflammatory diseases. Although there are an increasing number of studies of miRNAs in inflammatory upper and lower airway diseases, few miRNAs have been identified that directly link the upper and lower airways. In this article, therefore, we reviewed the relevant studies available in order to improve the understanding of the roles of miRNAs in the interaction and pathogenesis of UAD.

• allergic rhinitis
• asthma
• inflammation
• microRNA
• rhinosinusitis
• united airways disease

Allergic rhinitis (AR) is a common and increasing disease in which Dermatophagoides (D.) farinae is one of the most common causative allergens. The aims of this study were to confirm the presence of locally produced antibodies to D. farinae in nasal secretions between nasal provocation test (NPT)-positive and -negative groups of AR patients, to evaluate their relationships with the levels of inflammatory mediators, and to determine adaptive and innate immune responses in nasal mucosa.

Sixty AR patients sensitive to house dust mites confirmed by skin prick test or serum specific IgE to D. farinae underwent NPT for D. farinae. Nasal packs were placed in both nasal cavities of the patients for 5 minutes to obtain nasal secretions after NPT. The levels of total IgE, specific IgE to D. farinae, eosinophil cationic protein (ECP), and tryptase in nasal secretions were detected by using ImmunoCAP. The levels of specific IgE, IgA, and secretory IgA antibodies to D. farinae in nasal secretions were measured by using ELISA. The levels of IL-8, VEGF, IL-25, and IL-33 were also measured by using ELISA.

High levels of total IgE, specific IgE, specific IgA, and secretory IgA to D. farinae, as well as inflammatory mediators, such as ECP, IL-8, VEGF and tryptase, were detected in nasal secretions, although the differences were not statistically significant between the NPT-positive and NPT-negative groups. Levels of all immunoglobulins measured in this study significantly correlated with ECP, IL-8, and VEGF (P<0.05), but not with tryptase (P>0.05). IL-33 and IL-25 were also detected, and IL-25 level significantly correlated with IL-8 (r=0.625, P<0.001).

These findings confirmed the presence of locally produced specific antibodies, including D. farinae-specific IgE and IgA, in nasal secretions collected from D. farinae-sensitive AR patients in both the NPT-positive and NPT-negative groups, and close correlations were noted between antibodies and nasal inflammatory mediators, including such as ECP, IL-8 and VEGF, indicating that locally produced antibodies may be involved in the nasal inflammation of AR.

• Allergic rhinitis
• local specific antibody
• nasal mucosa

• Chronic rhinosinusitis
• asthma
• longitudinal

• IgE
• Mouse model
• allergic rhinitis
• ethyl pyruvate
• high mobility group box 1

• Animals
• Anti-Inflammatory Agents/chemistry
• Cytokines/metabolism
• Disease Models, Animal
• Enzyme-Linked Immunosorbent Assay
• HMGB1 Protein/metabolism
• Immunoglobulin E/blood
• Immunohistochemistry
• Inflammation
• Male
• Mice
• Mice, Inbred BALB C
• Ovalbumin/chemistry
• Pyruvates/chemistry
• Rhinitis, Allergic/drug therapy
• Rhinitis, Allergic/pathology
• Toll-Like Receptor 4/metabolism
• Up-Regulation

Significant links between allergic rhinitis and asthma have been reported, and the united airway disease hypothesis is supported by numerous findings in epidemiologic, physiologic, pathologic, and immunologic studies. The impact of allergic rhinitis on asthma has been established. On the other hand, the relationship between chronic rhinosinusitis and lung diseases has been under investigation. Chronic rhinosinusitis is a common disease, and the high prevalence of chronic rhinosinusitis in some kinds of lung diseases has been reported. Recent studies suggest that the treatment of chronic rhinosinusitis has beneficial effects in the management of asthma. Here, we present an overview of the current research on the relationship between chronic rhinosinusitis and lower airway diseases including asthma, chronic obstructive pulmonary disease, cystic fibrosis, diffuse panbronchiolitis, primary ciliary dyskinesia, idiopathic bronchiectasis, and allergic bronchopulmonary aspergillosis.

• Chronic rhinosinusitis
• Sinusitis
• Asthma
• Chronic obstructive pulmonary disease
• Cystic fibrosis
• Diffuse panbronchiolitis
• Primary ciliary dyskinesia
• Idiopathic bronchiectasis
• Allergic bronchopulmonary aspergillosis

• administration
• sublingual
• desensitization
• immunologic
• patient compliance
• rhinitis
• allergic
• seasonal

• Adolescent
• Adult
• Data Collection
• Female
• Humans
• Italy/epidemiology
• Male
• Middle Aged
• Patient Satisfaction
• Rhinitis, Allergic/epidemiology
• Rhinitis, Allergic/pathology
• Skin Tests
• Treatment Outcome
• Young Adult

• Allergic rhinitis
• Allergy
• Asthma
• Atopic dermatitis
• Food allergy
• Mouse models

Current literature related to asthma diagnosis, epidemiology, pathogenesis, and treatment linked with rhinosinusitis is important. Asthma is very heterogeneous; new theories and treatments are emerging. It is a growing epidemic among children and adults in the United States and the severity of asthma is caused by many factors such as lack of education, poor early recognition, decreased symptom awareness, improper medications, and phenotypic changes. Genetic variation, innate immune genes, those involved in tissue remodeling and arachidonic acid metabolism, and inflammatory mediators might contribute to the pathogenesis of chronic rhinosinusitis (CRS) linked with asthma. This extensive review addresses concepts of the burden of asthma and sinusitis, altered innate immunity, adaptive immunity, asthma remodeling, the airway epithelium, the role of airway smooth muscle cells, united allergic airway, genetics, an integral part in asthma, and CRS. In addition, the role of vitamin D in both asthma and CRS in the elderly and pediatric population, various treatment options, and exhaled nitric oxide are briefly addressed.