Page 72 - Portuguese Journal - SPORL - Vol 61. Nº1
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and hyposmia or anosmia. In addition, the there is a considerable percentage of patients
diagnosis requires endoscopic signs of the who have recurrent disease even after all the
disease (nasal polyps and/or mucopurulent conventional medical measures and surgical
rhinorrhea draining from the middle meatus interventions have been used . This is the
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and/or edema/ mucus obstruction primarily group of patients that is expected to benefit
in the middle meatus) and/or changes in from a potential biological therapy.
computed tomography (CT) (changes in the CRS has been classified into two distinct
mucosa of the osteomeatal complex and/or clinical phenotypes, CRS with nasal polyps
paranasal sinuses). For the diagnosis of CRS and without nasal polyps. Despite the
to be valid, the symptoms must be present knowledge that inflammation is at the base of
for a minimum period of 12 weeks. CRS with this disease, the elucidation of the underlying
nasal polyps (CRSwNP) is characterized by the mechanisms remains unsatisfactory. It is
presence of bilateral nasal polyps detected believed that CRS is a clinical syndrome
by nasal endoscopy in addition to the above that corresponds to the common final
described criteria . manifestation of multiple pathophysiological
1,2
CRS is a disease with a high impact in terms of pathways that affect the nasal cavities and
morbidity of the affected population and the paranasal sinuses. It is known that there is
health costs associated with the disease itself an association between CRS without nasal
and with the periods of work absenteeism . polyps and type 1 inflammation and in the
3
With regard to its epidemiology, two studies case of CRSwNP, a stronger association with
were conducted based on nasal endoscopy in type 2 inflammation. This type 2 inflammation
Portugal. In the first study, conducted in the is more frequently associated with an increase
north of Portugal, a group of 200 Caucasian in inflammatory factors, including IL-4, IL-5, IL-
cadavers was analyzed and the prevalence 13, and IgE, and these mediators may serve
of nasal polyps was found to be 5.5% . In as potential therapeutic targets for the novel
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the second study, conducted in 2018, the biological treatment of CRSwNP .
3
prevalence of CRSwNP among 215 textile One of the first biological therapies introduced
industry workers was 8.8%, that is, significantly was omalizumab. It acts as a human
higher than that found among 101 retail sales monoclonal anti-IgE antibody that binds to
workers (0%). This suggests a correlation free IgE molecules, thereby decreasing their
between occupational exposure to dust and circulating levels. In turn, this reduction leads
the occurrence of nasal polyposis . to a decrease in the rate of IgE binding to its
5
In another study conducted by the same receptor in basophils and mast cells, thus
group of researchers, the rate of relapse in 85 inhibiting their degranulation and subsequent
patients who underwent surgery and follow- release of cytokines and inflammatory
up for a minimum period of nine months while mediators .
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receiving intranasal glucocorticoids was 31% . IL-5 plays a role in differentiation, chemotaxis,
6
In these patients, aspects such as occupational and eosinophil survival, and eosinophils play
exposure to dust and the concomitant an important role in type 2 inflammation.
presence of non-IgE mediated asthma were Monoclonal antibodies such as mepolizumab
identified as the predictive factors for disease act as anti-IL-5 therapy as they have a high
relapse. A systematic review of the role of affinity for IL-5. The therapeutic target of
functional endoscopic sinus surgery (FESS) in benralizumab is the IL-5 receptor, which is
the treatment of CRSwNP showed that disease expressed on the surface of both eosinophils
recurrence after FESS varied between 4% and and basophils. It can inhibit the binding of IL-5
60%, with a median of 20% in all studies; in the to its receptors and thus causes cytotoxicity
case of revision surgery, the interval was 3% mediated by antibody-dependent cells (8).
to 42% with a median of 6% . This implies that IL-4 and IL-13 activate type 2 inflammatory
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72 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery
