Rhinitis Subtypes, Endotypes, and Definitions

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Abstract

Rhinitis is often seen as posing a small burden. However, rhinitis is a complex disease that is underpinned by a plethora of different mechanisms and causes. Rhinitis is frequently associated with other comorbid conditions but, by itself, is a source of considerable morbidity for patients and creates a significant financial burden on health systems worldwide. This article approaches this condition from both a phenotypic and mechanistic standpoint, focusing on the complexity of characterizing these subtypes. Developing a clearer demarcation of the currently obscure rhinitis phenotypes and endotypes will substantially improve their future prevention and treatment.

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Most cited references 107

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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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Chronic rhinosinusitis (CRS) clinically is a heterogeneous group of sinus diseases, which may cover different disease entities, or may represent a disease continuum. Studying inflammatory cells and mediators in clearly defined disease subgroups may lead to a better differentiation of chronic sinus diseases. Sinonasal mucosal tissue from 10 nasal polyp (NP) patients, 13 cystic fibrosis patients (CF-NP), eight CRS subjects without polyps, and nine control patients were stained for CD3, CD25, CD68, CD20, myeloperoxidase (MPO), CD138 and tissue homogenates were assayed for eotaxin, interleukin (IL)-1beta, IL-2sRalpha, IL-5, interferon (IFN)-gamma, IL-8, transforming growth factor (TGF)-beta1, tumor necrosis factor-alpha, and MPO by enzyme-linked immunosorbent assay or UNICAP system. Nasal polyp and CF-NP showed increased numbers and activation of T cells, while only NP displayed an increase in plasma cells. Nasal polyp had significantly higher levels of eosinophilic markers [eosinophils, eotaxin, and eosinophil cationic protein (ECP)] compared with CRS, controls and CF-NP. Chronic rhinosinusitis was characterized by a Th1 polarization with high levels of IFN-gamma and TGF-beta, while NP showed a Th2 polarization with high IL-5 and immunoglobulin (Ig) E concentrations. Nasal polyp and CF-NP were discriminated by edema from CRS and controls, with CF-NP displaying a very prominent neutrophilic inflammation. Based on cellular and mediator profiles, we suggest that CRS, NP, and CF-NP are distinct disease entities within the group of chronic sinus diseases.

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Author and article information

Contributors

Nikolaos G. Papadopoulos

Journal

Journal ID (nlm-ta): Immunol Allergy Clin North Am

Journal ID (iso-abbrev): Immunol Allergy Clin North Am

Title: Immunology and Allergy Clinics of North America

Publisher: Elsevier Inc.

ISSN (Print): 0889-8561

ISSN (Electronic): 1557-8607

Publication date PMC-release: 28 February 2016

Publication date (Print): May 2016

Publication date (Electronic): 28 February 2016

Volume: 36

Issue: 2

Pages: 215-233

Affiliations

[a ]Centre of Paediatrics and Child Health, Institute of Human Development, University of Manchester, Oxford Road, Manchester M13 9WL, UK

[b ]Department of Pediatric Immunology, Royal Manchester Children’s Hospital, Central Manchester University Hospitals Trust, Oxford Road, Manchester M13 9WL, UK

[c ]Allergy Department, 2nd University Pediatrics Clinic, University of Athens, Aglaia Kyriakou Childrens Hospital, Thivon & Livadeias, Athens 11527, Greece

Author notes

[∗ ]Corresponding author. St Mary’s Hospital, 5th Floor, Research, Oxford Road, Manchester M13 9WL, UK. ngp@ 123456allergy.gr

Article

Publisher ID: S0889-8561(15)00112-5

DOI: 10.1016/j.iac.2015.12.001

PMC ID: 7127043

PubMed ID: 27083098

SO-VID: d6cda73f-c14d-4b47-9fa5-c01fd27a03d7

License:

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