Chronic rhinosinusitis precipitated by tumor necrosis factor alpha inhibitors is the phenotype of chronic rhinosinusitis without nasal polyps
Background Chronic rhinosinusitis (CRS) is a frequently observed condition in patients with immunodeficiency secondary to tumor necrosis factor alpha inhibitors (TNFαis). The histologic features of CRS caused by TNFαis have yet to be determined and may have important implications in understanding th...
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| Veröffentlicht in: | International forum of allergy & rhinology 2020-01, Vol.10 (1), p.23-28 |
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| creator | Papagiannopoulos, Peter Devins, Kyle Tong, Charles Ching Lick Yver, Christina Patel, Neil N. Kuhar, Hannah N. Bosso, John V. Kohanski, Michael A. Tajudeen, Bobby A. Kuan, Edward C. Batra, Pete S. Cohen, Noam A. Kennedy, David W. Palmer, James N. Montone, Kathy Adappa, Nithin D. |
| description | Background
Chronic rhinosinusitis (CRS) is a frequently observed condition in patients with immunodeficiency secondary to tumor necrosis factor alpha inhibitors (TNFαis). The histologic features of CRS caused by TNFαis have yet to be determined and may have important implications in understanding the pathophysiology of the disease process.
Methods
A structured histopathology report was used to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). These structured histopathology variables were compared among patients with CRS on TNFαi (CRSαi), CRS without nasal polyps (CRSsNP) patients, and CRS with nasal polyps (CRSwNP) patients.
Results
Eighteen CRSαi, 91 CRSwNP, and 113 CRSsNP patients undergoing FESS were analyzed. Compared to CRSsNP, CRSαi patients exhibited increased mucosal ulceration (16.7% vs 0.9%, p |
| doi_str_mv | 10.1002/alr.22462 |
| format | Article |
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Chronic rhinosinusitis (CRS) is a frequently observed condition in patients with immunodeficiency secondary to tumor necrosis factor alpha inhibitors (TNFαis). The histologic features of CRS caused by TNFαis have yet to be determined and may have important implications in understanding the pathophysiology of the disease process.
Methods
A structured histopathology report was used to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). These structured histopathology variables were compared among patients with CRS on TNFαi (CRSαi), CRS without nasal polyps (CRSsNP) patients, and CRS with nasal polyps (CRSwNP) patients.
Results
Eighteen CRSαi, 91 CRSwNP, and 113 CRSsNP patients undergoing FESS were analyzed. Compared to CRSsNP, CRSαi patients exhibited increased mucosal ulceration (16.7% vs 0.9%, p < 0.008), increased fibrosis (100% vs 34.5%, p < 0.001), and increased presence of Charcot‐Leiden crystals (16.7% vs 0%, p < 0.002). Compared to CRSwNP, CRSαi patients demonstrated increased fibrosis (100% vs 54.9%, p < 0.001), decreased presence of subepithelial edema (44.4% vs 69.2% p < 0.043), decreased eosinophil aggregates (22.2% vs 47.3% p < 0.042), and fewer eosinophils per high‐power field (44.4% vs 73.6%, p < 0.017).
Conclusion
CRSαi exhibits structured histopathology more similar to CRSsNP. In the appropriate clinical context, it may be reasonable that the medical regimen for these patients be focused on a more antineutrophilic, macrolide‐based approach. This study provides insight into the inflammatory environment of patients with CRSαi and may have implications for disease management.]]></description><identifier>ISSN: 2042-6976</identifier><identifier>EISSN: 2042-6984</identifier><identifier>DOI: 10.1002/alr.22462</identifier><identifier>PMID: 31794110</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Charcot-Leyden crystal protein ; Edema ; Fibrosis ; Histopathology ; Immunodeficiency ; Inflammation ; Leukocytes (eosinophilic) ; Mucosa ; Necrosis ; pathology ; Patients ; Phenotypes ; Polyps ; Rhinitis ; Rhinosinusitis ; Sinusitis ; Surgery ; therapeutics ; treatment outcome ; tumor necrosis factor alpha ; Tumor necrosis factor-TNF ; Tumor necrosis factor-α</subject><ispartof>International forum of allergy & rhinology, 2020-01, Vol.10 (1), p.23-28</ispartof><rights>2019 ARS‐AAOA, LLC</rights><rights>2019 ARS-AAOA, LLC.</rights><rights>2020 ARS‐AAOA, LLC</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3532-d8e7b3503360a42de85a631b8a46ea3a6ee788b011ff40a7e493ca42ee2cc7f53</citedby><cites>FETCH-LOGICAL-c3532-d8e7b3503360a42de85a631b8a46ea3a6ee788b011ff40a7e493ca42ee2cc7f53</cites><orcidid>0000-0002-4471-5134 ; 0000-0003-1365-9130 ; 0000-0003-4276-1193 ; 0000-0003-3475-0718</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Falr.22462$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Falr.22462$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31794110$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Papagiannopoulos, Peter</creatorcontrib><creatorcontrib>Devins, Kyle</creatorcontrib><creatorcontrib>Tong, Charles Ching Lick</creatorcontrib><creatorcontrib>Yver, Christina</creatorcontrib><creatorcontrib>Patel, Neil N.</creatorcontrib><creatorcontrib>Kuhar, Hannah N.</creatorcontrib><creatorcontrib>Bosso, John V.</creatorcontrib><creatorcontrib>Kohanski, Michael A.</creatorcontrib><creatorcontrib>Tajudeen, Bobby A.</creatorcontrib><creatorcontrib>Kuan, Edward C.</creatorcontrib><creatorcontrib>Batra, Pete S.</creatorcontrib><creatorcontrib>Cohen, Noam A.</creatorcontrib><creatorcontrib>Kennedy, David W.</creatorcontrib><creatorcontrib>Palmer, James N.</creatorcontrib><creatorcontrib>Montone, Kathy</creatorcontrib><creatorcontrib>Adappa, Nithin D.</creatorcontrib><title>Chronic rhinosinusitis precipitated by tumor necrosis factor alpha inhibitors is the phenotype of chronic rhinosinusitis without nasal polyps</title><title>International forum of allergy & rhinology</title><addtitle>Int Forum Allergy Rhinol</addtitle><description><![CDATA[Background
Chronic rhinosinusitis (CRS) is a frequently observed condition in patients with immunodeficiency secondary to tumor necrosis factor alpha inhibitors (TNFαis). The histologic features of CRS caused by TNFαis have yet to be determined and may have important implications in understanding the pathophysiology of the disease process.
Methods
A structured histopathology report was used to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). These structured histopathology variables were compared among patients with CRS on TNFαi (CRSαi), CRS without nasal polyps (CRSsNP) patients, and CRS with nasal polyps (CRSwNP) patients.
Results
Eighteen CRSαi, 91 CRSwNP, and 113 CRSsNP patients undergoing FESS were analyzed. Compared to CRSsNP, CRSαi patients exhibited increased mucosal ulceration (16.7% vs 0.9%, p < 0.008), increased fibrosis (100% vs 34.5%, p < 0.001), and increased presence of Charcot‐Leiden crystals (16.7% vs 0%, p < 0.002). Compared to CRSwNP, CRSαi patients demonstrated increased fibrosis (100% vs 54.9%, p < 0.001), decreased presence of subepithelial edema (44.4% vs 69.2% p < 0.043), decreased eosinophil aggregates (22.2% vs 47.3% p < 0.042), and fewer eosinophils per high‐power field (44.4% vs 73.6%, p < 0.017).
Conclusion
CRSαi exhibits structured histopathology more similar to CRSsNP. In the appropriate clinical context, it may be reasonable that the medical regimen for these patients be focused on a more antineutrophilic, macrolide‐based approach. This study provides insight into the inflammatory environment of patients with CRSαi and may have implications for disease management.]]></description><subject>Charcot-Leyden crystal protein</subject><subject>Edema</subject><subject>Fibrosis</subject><subject>Histopathology</subject><subject>Immunodeficiency</subject><subject>Inflammation</subject><subject>Leukocytes (eosinophilic)</subject><subject>Mucosa</subject><subject>Necrosis</subject><subject>pathology</subject><subject>Patients</subject><subject>Phenotypes</subject><subject>Polyps</subject><subject>Rhinitis</subject><subject>Rhinosinusitis</subject><subject>Sinusitis</subject><subject>Surgery</subject><subject>therapeutics</subject><subject>treatment outcome</subject><subject>tumor necrosis factor alpha</subject><subject>Tumor necrosis factor-TNF</subject><subject>Tumor necrosis factor-α</subject><issn>2042-6976</issn><issn>2042-6984</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp10U1LBCEcBnCJoqI69AVC6FKHLd9mnD3G0hssBFHnwXH_w7jMqqlDzIfoO-e2tYcoLyr-eBQfhE4puaKEsGvVhyvGRMl20CEjgk3KaSV2t2tZHqCTGJckj4IWBZX76IBTORWUkkP0MeuCs0bj0BnrorFDNMlE7ANo401SCRa4GXEaVi5gCzpkFHGrdMp71ftOYWM705i8jzgfpQ6w78C6NHrArsX67xveTerckLBVUfXYu3708RjttaqPcPI9H6HXu9uX2cNk_nT_OLuZTzQvOJssKpANLwjnJVGCLaAqVMlpUylRguKqBJBV1RBK21YQJUFMuc4QgGkt24IfoYtNrg_ubYCY6pWJGvpeWXBDrBlnpJJcMJnp-S-6dEOw-XVZrVkhRJnV5Uat_ycGaGsfzEqFsaakXtdU55rqr5qyPftOHJoVLLbyp5QMrjfg3fQw_p9U38yfN5Gf0kWfTQ</recordid><startdate>202001</startdate><enddate>202001</enddate><creator>Papagiannopoulos, Peter</creator><creator>Devins, Kyle</creator><creator>Tong, Charles Ching Lick</creator><creator>Yver, Christina</creator><creator>Patel, Neil N.</creator><creator>Kuhar, Hannah N.</creator><creator>Bosso, John V.</creator><creator>Kohanski, Michael A.</creator><creator>Tajudeen, Bobby A.</creator><creator>Kuan, Edward C.</creator><creator>Batra, Pete S.</creator><creator>Cohen, Noam A.</creator><creator>Kennedy, David W.</creator><creator>Palmer, James N.</creator><creator>Montone, Kathy</creator><creator>Adappa, Nithin D.</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4471-5134</orcidid><orcidid>https://orcid.org/0000-0003-1365-9130</orcidid><orcidid>https://orcid.org/0000-0003-4276-1193</orcidid><orcidid>https://orcid.org/0000-0003-3475-0718</orcidid></search><sort><creationdate>202001</creationdate><title>Chronic rhinosinusitis precipitated by tumor necrosis factor alpha inhibitors is the phenotype of chronic rhinosinusitis without nasal polyps</title><author>Papagiannopoulos, Peter ; Devins, Kyle ; Tong, Charles Ching Lick ; Yver, Christina ; Patel, Neil N. ; Kuhar, Hannah N. ; Bosso, John V. ; Kohanski, Michael A. ; Tajudeen, Bobby A. ; Kuan, Edward C. ; Batra, Pete S. ; Cohen, Noam A. ; Kennedy, David W. ; Palmer, James N. ; Montone, Kathy ; Adappa, Nithin D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3532-d8e7b3503360a42de85a631b8a46ea3a6ee788b011ff40a7e493ca42ee2cc7f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Charcot-Leyden crystal protein</topic><topic>Edema</topic><topic>Fibrosis</topic><topic>Histopathology</topic><topic>Immunodeficiency</topic><topic>Inflammation</topic><topic>Leukocytes (eosinophilic)</topic><topic>Mucosa</topic><topic>Necrosis</topic><topic>pathology</topic><topic>Patients</topic><topic>Phenotypes</topic><topic>Polyps</topic><topic>Rhinitis</topic><topic>Rhinosinusitis</topic><topic>Sinusitis</topic><topic>Surgery</topic><topic>therapeutics</topic><topic>treatment outcome</topic><topic>tumor necrosis factor alpha</topic><topic>Tumor necrosis factor-TNF</topic><topic>Tumor necrosis factor-α</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Papagiannopoulos, Peter</creatorcontrib><creatorcontrib>Devins, Kyle</creatorcontrib><creatorcontrib>Tong, Charles Ching Lick</creatorcontrib><creatorcontrib>Yver, Christina</creatorcontrib><creatorcontrib>Patel, Neil N.</creatorcontrib><creatorcontrib>Kuhar, Hannah N.</creatorcontrib><creatorcontrib>Bosso, John V.</creatorcontrib><creatorcontrib>Kohanski, Michael A.</creatorcontrib><creatorcontrib>Tajudeen, Bobby A.</creatorcontrib><creatorcontrib>Kuan, Edward C.</creatorcontrib><creatorcontrib>Batra, Pete S.</creatorcontrib><creatorcontrib>Cohen, Noam A.</creatorcontrib><creatorcontrib>Kennedy, David W.</creatorcontrib><creatorcontrib>Palmer, James N.</creatorcontrib><creatorcontrib>Montone, Kathy</creatorcontrib><creatorcontrib>Adappa, Nithin D.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>International forum of allergy & rhinology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Papagiannopoulos, Peter</au><au>Devins, Kyle</au><au>Tong, Charles Ching Lick</au><au>Yver, Christina</au><au>Patel, Neil N.</au><au>Kuhar, Hannah N.</au><au>Bosso, John V.</au><au>Kohanski, Michael A.</au><au>Tajudeen, Bobby A.</au><au>Kuan, Edward C.</au><au>Batra, Pete S.</au><au>Cohen, Noam A.</au><au>Kennedy, David W.</au><au>Palmer, James N.</au><au>Montone, Kathy</au><au>Adappa, Nithin D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Chronic rhinosinusitis precipitated by tumor necrosis factor alpha inhibitors is the phenotype of chronic rhinosinusitis without nasal polyps</atitle><jtitle>International forum of allergy & rhinology</jtitle><addtitle>Int Forum Allergy Rhinol</addtitle><date>2020-01</date><risdate>2020</risdate><volume>10</volume><issue>1</issue><spage>23</spage><epage>28</epage><pages>23-28</pages><issn>2042-6976</issn><eissn>2042-6984</eissn><abstract><![CDATA[Background
Chronic rhinosinusitis (CRS) is a frequently observed condition in patients with immunodeficiency secondary to tumor necrosis factor alpha inhibitors (TNFαis). The histologic features of CRS caused by TNFαis have yet to be determined and may have important implications in understanding the pathophysiology of the disease process.
Methods
A structured histopathology report was used to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). These structured histopathology variables were compared among patients with CRS on TNFαi (CRSαi), CRS without nasal polyps (CRSsNP) patients, and CRS with nasal polyps (CRSwNP) patients.
Results
Eighteen CRSαi, 91 CRSwNP, and 113 CRSsNP patients undergoing FESS were analyzed. Compared to CRSsNP, CRSαi patients exhibited increased mucosal ulceration (16.7% vs 0.9%, p < 0.008), increased fibrosis (100% vs 34.5%, p < 0.001), and increased presence of Charcot‐Leiden crystals (16.7% vs 0%, p < 0.002). Compared to CRSwNP, CRSαi patients demonstrated increased fibrosis (100% vs 54.9%, p < 0.001), decreased presence of subepithelial edema (44.4% vs 69.2% p < 0.043), decreased eosinophil aggregates (22.2% vs 47.3% p < 0.042), and fewer eosinophils per high‐power field (44.4% vs 73.6%, p < 0.017).
Conclusion
CRSαi exhibits structured histopathology more similar to CRSsNP. In the appropriate clinical context, it may be reasonable that the medical regimen for these patients be focused on a more antineutrophilic, macrolide‐based approach. This study provides insight into the inflammatory environment of patients with CRSαi and may have implications for disease management.]]></abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31794110</pmid><doi>10.1002/alr.22462</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-4471-5134</orcidid><orcidid>https://orcid.org/0000-0003-1365-9130</orcidid><orcidid>https://orcid.org/0000-0003-4276-1193</orcidid><orcidid>https://orcid.org/0000-0003-3475-0718</orcidid></addata></record> |
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| subjects | Charcot-Leyden crystal protein Edema Fibrosis Histopathology Immunodeficiency Inflammation Leukocytes (eosinophilic) Mucosa Necrosis pathology Patients Phenotypes Polyps Rhinitis Rhinosinusitis Sinusitis Surgery therapeutics treatment outcome tumor necrosis factor alpha Tumor necrosis factor-TNF Tumor necrosis factor-α |
| title | Chronic rhinosinusitis precipitated by tumor necrosis factor alpha inhibitors is the phenotype of chronic rhinosinusitis without nasal polyps |
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