Endotypes and phenotypes of chronic rhinosinusitis: A PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy.

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Presentation transcript:

Endotypes and phenotypes of chronic rhinosinusitis: A PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology Cezmi A. Akdis, MD, Claus Bachert, MD, PhD, Cemal Cingi, MD, Mark S. Dykewicz, MD, Peter W. Hellings, MD, Robert M. Naclerio, MD, Robert P. Schleimer, MD, Dennis Ledford, MD Journal of Allergy and Clinical Immunology Volume 131, Issue 6, Pages 1479-1490 (June 2013) DOI: 10.1016/j.jaci.2013.02.036 Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Pathomechanisms of CRS. A, CRSwNP. In a TH2-type microenvironment with general lack of regulatory T (Treg) cell function, IL-5 induces eosinophilia, and IL-4 and IL-13 induce local IgE production. An alternatively activated macrophage subset contributes to the inflammation. The activation of epithelium colonized by bacteria and fungi leads to release of proinflammatory chemokines and cytokines with increased thymic stromal lymphopoietin (TSLP) and IL-32 levels. Activated epithelial cells die, with apoptosis resulting in a compromised epithelial barrier. B, CRSsNP. Instead of a TH2-skewed T-cell response, a TH1 or a mixed TH0 response predominates, neutrophilia is often associated, and expression of TGF-β and its receptors is increased. DC, Dendritic cell. Journal of Allergy and Clinical Immunology 2013 131, 1479-1490DOI: (10.1016/j.jaci.2013.02.036) Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Key phenotypes in relationship to proposed endotypes and their possible associations are shown. ASA, Aspirin. Journal of Allergy and Clinical Immunology 2013 131, 1479-1490DOI: (10.1016/j.jaci.2013.02.036) Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 Algorithm for the follow-up of patients with CRSwNP (A) and CRSsNP (B). CSF, Cerebrospinal fluid. Journal of Allergy and Clinical Immunology 2013 131, 1479-1490DOI: (10.1016/j.jaci.2013.02.036) Copyright © 2013 American Academy of Allergy, Asthma & Immunology Terms and Conditions