| ‣ |
|---|
| ‣ |
Figure 3: (A) Intraoperative endoscopic view of an inflammatory nasal polyp (NP) in the left nasal cavity, characteristic of chronic rhinosinusitis with nasal polyposis. (B) Intraoperative endoscopic view of purulent discharge (D) in the right nasal cavity, characteristic of chronic rhinosinusitis without nasal polyposis. Note: IT = inferior turbinate, MT = middle turbinate, S = septum
ILC = innate lymphoid Cells. Type 2 responds well to Biologics.
| Endotype (Inflammatory Response) | Type 1 | Type 2 | Type 3 |
|---|---|---|---|
| Immune Cells | ILC1, Th1 | ILC2, Th2 | ILC3, Th17 |
| Cytokine | IL - 6,8,18 | IL - 4,5,13 | IL 17, 22, 23 |
| Biologics | — | Yes | — |
Fokkens WJ, De Corso E, Backer V, Bernal-Sprekelsen M, Bjermer L, Von Buchwald C, et al. EPOS2020/EUFOREA expert opinion on defining disease states and therapeutic goals in CRSwNP. Rhinol J. 2024 Jan 1;0(0):0–0. doi:10.4193/Rhin23.415
| Biologic types | initiation dates | MOA | A/E | contraindication |
|---|---|---|---|---|
| **‣ *** | 2020 | IL-4Rα antagonist → blocks IL-4 & IL-13 signaling | ‣ , ‣ , ‣ | treat ‣ infections first; avoid live vaccines |
| **‣ *** | 2021 | Anti-IgE → prevents IgE binding to FcεRI receptors | headache; rare anaphylaxis | ‣ |
| **‣ *** | 2021 | Anti-IL-5 → ↓ eosinophil maturation & survival | Headache, fatigue, ‣ | treat ‣ infections first |
| ‣ | 2022 | Anti-IL-5Rα → antibody-dependent eosinophil depletion | Headache, ‣ , | treat ‣ infections first |
*Also indicated for Ashma and atopic dermatitis.