Literature DB >> 31296254

Correction to: Clinically relevant phenotypes in chronic rhinosinusitis.

Jessica W Grayson1, Marina Cavada2,3, Richard J Harvey2,3.   

Abstract

Following publication of the original article [1], the authors reported an error in Table 1. In the second columns of the 'Radiology' row, 'Normal anterolateral sinus mucosa' should read 'Normal superolateral sinus mucosa'. A corrected version of Table 1 is included in this Correction.

Entities:  

Year:  2019        PMID: 31296254      PMCID: PMC6625072          DOI: 10.1186/s40463-019-0355-6

Source DB:  PubMed          Journal:  J Otolaryngol Head Neck Surg        ISSN: 1916-0208


Correction to: J Otolaryngol Head Neck Surg https://doi.org/10.1186/s40463-019-0350-y Following publication of the original article [1], the authors reported an error in Table 1. In the second columns of the ‘Radiology’ row, ‘Normal anterolateral sinus mucosa’ should read ‘Normal superolateral sinus mucosa’. A corrected version of Table 1 is included in this Correction.
Table 1

Summary of Key Findings of CRS Phenotypes

Phenotype
CharacteristicsCCAD (IgE mediated)eCRS (AERD)Non-eCRS
Clinical Presentation

- Young onset (teens to 20s)

- Rhinitis symptoms

- Smell preserved

- Other atopic disease:

° Childhood asthma

° conjunctival symptoms, dermatitis

- Mid-Life “adult” onset (30–50 yo)

- Occasionally post respiratory virus

- “Completely well” prior to onset or if allergic, then symptoms limited to childhood

- Smell loss (corticosteroid responsive)

- Antibiotic seeking

- Food and alcohol induced flares

- Adult onset asthma linked temporally to CRS onset.

- Older onset 50 yrs.+

- Female, obese

- Cough

- Poor corticosteroid response

- “Asthma” present but often poor response to inhaled preventive therapy (corticosteroid based)

Endoscopy

- Middle turbinate edema

- Polypoid changes from turbinates and septum

- No thick mucin

- Normal sinus mucosa on surgery

- Polyps (small, multiple, large) from the middle meatus

- Thick eosinophilic mucin

- Secondary purulence

- Polyps or polypoid edema

- Purulent secretions

- Lack of eosinophilic mucin

Radiology

- Central thickening of septum and turbinates, peripheral clearing (CCAD)

- Mucus trapping only in sinsues

- Normal superolateral sinus mucosa (“black halo”)

- Pan-sinusitis (Lund-Mackay 24)

- Neo-osteogenesis

- Pan-sinusitis (undistinguishable from eCRS)
Histopathology

- Elevated tissue eosinophilia

- Often without activation (no eosinophil aggregates and charcot-leyden crystals)

- No serum eosinophils

- Elevated total and specific IgE

- Elevated tissue eosinophilia (>10eos/hpf, but often >100eos/hpf)

- Evidence of eosinophil activation (eosinophil aggregates and charcot-leyden crystals)

- Serum eosinophilia

- Lack of tissue eosinophilia (< 10/HPF)
Allergy

- + allergy testing (dustmite/perennial allergens)

- Often monoallergen-sensitized

- Either negative IgE sensitization or multi-allergen sensitized- Negative skin prick, immunocap/RAST
Treatment

- Allergen directed immunotherapy

- Endoscopic sinus surgery

- Topical corticosteroid (spray or irrigation)

- Systemic corticosteroid treatment (up to 2–3 times per year) if limited burden of disease

- Endoscopic sinus surgery (Draf 3)

- Topical corticosteroid irrigations (not sprays)

For AERD:

- Zileuton, Montelukast, Zafirlukast

- Can take selective COX-2 inhibitors (Meloxicam)

- Saline or corticosteroid irrigations

- Endoscopic sinus surgery

- Macrolide therapy (Clarithromycin 250 mg daily for 3 months)

- Continue 3/week until 12 months if responder

Difficult to control disease- Omaluzimab (anti-IgE)

- Mepoluzimab (anti-IL5)

- Other immune-modulating therapy (Benraluzimab, Dupiliumab, Reslizumab, etc)

For AERD:

- ASA desensitization (1300 mg commencement and 350–700 mg daily maintenance)

- Consider re-biopsy of a patient post-surgery and post-corticosteroid based treatment if not responding and may be re-classified under this phenotype
Summary of Key Findings of CRS Phenotypes - Young onset (teens to 20s) - Rhinitis symptoms - Smell preserved - Other atopic disease: ° Childhood asthma ° conjunctival symptoms, dermatitis - Mid-Life “adult” onset (30–50 yo) - Occasionally post respiratory virus - “Completely well” prior to onset or if allergic, then symptoms limited to childhood - Smell loss (corticosteroid responsive) - Antibiotic seeking - Food and alcohol induced flares - Adult onset asthma linked temporally to CRS onset. - Older onset 50 yrs.+ - Female, obese - Cough - Poor corticosteroid response - “Asthma” present but often poor response to inhaled preventive therapy (corticosteroid based) - Middle turbinate edema - Polypoid changes from turbinates and septum - No thick mucin - Normal sinus mucosa on surgery - Polyps (small, multiple, large) from the middle meatus - Thick eosinophilic mucin - Secondary purulence - Polyps or polypoid edema - Purulent secretions - Lack of eosinophilic mucin - Central thickening of septum and turbinates, peripheral clearing (CCAD) - Mucus trapping only in sinsues - Normal superolateral sinus mucosa (“black halo”) - Pan-sinusitis (Lund-Mackay 24) - Neo-osteogenesis - Elevated tissue eosinophilia - Often without activation (no eosinophil aggregates and charcot-leyden crystals) - No serum eosinophils - Elevated total and specific IgE - Elevated tissue eosinophilia (>10eos/hpf, but often >100eos/hpf) - Evidence of eosinophil activation (eosinophil aggregates and charcot-leyden crystals) - Serum eosinophilia - + allergy testing (dustmite/perennial allergens) - Often monoallergen-sensitized - Allergen directed immunotherapy - Endoscopic sinus surgery - Topical corticosteroid (spray or irrigation) - Systemic corticosteroid treatment (up to 2–3 times per year) if limited burden of disease - Endoscopic sinus surgery (Draf 3) - Topical corticosteroid irrigations (not sprays) For AERD: - Zileuton, Montelukast, Zafirlukast - Can take selective COX-2 inhibitors (Meloxicam) - Saline or corticosteroid irrigations - Endoscopic sinus surgery - Macrolide therapy (Clarithromycin 250 mg daily for 3 months) - Continue 3/week until 12 months if responder - Mepoluzimab (anti-IL5) - Other immune-modulating therapy (Benraluzimab, Dupiliumab, Reslizumab, etc) For AERD: - ASA desensitization (1300 mg commencement and 350–700 mg daily maintenance)
  1 in total

Review 1.  Clinically relevant phenotypes in chronic rhinosinusitis.

Authors:  Jessica W Grayson; Marina Cavada; Richard J Harvey
Journal:  J Otolaryngol Head Neck Surg       Date:  2019-05-29
  1 in total
  1 in total

1.  Histopathological analysis of sinonasal lesions associated with chronic rhinosinusitis and comparison with computed tomography diagnoses.

Authors:  Sultan Abdulwadoud Alshoabi; Abdulkhaleq Ayedh Binnuhaid; Moawia Bushra Gameraddin; Kamal Dahhan Alsultan
Journal:  Pak J Med Sci       Date:  2020 Jan-Feb       Impact factor: 1.088

  1 in total

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