Сlinical and allergological characteristics of chronic inflammatory diseases of the nose in patients with severe bronchial asthma receiving immunobiological therapy in the Sverdlovsk region

Introduction. Allergic rhinitis, chronic rhinosinusitis (with/without polyps) are chronic inflammatory diseases of the nose and often accompany asthma, aggravating its severity.

Aim of the study. Тo determine the phenotypes, spectrum of sensitization and severity of chronic inflammatory diseases of the nose in patients with severe bronchial asthma receiving immunobiological therapy in the Sverdlovsk region.

Materials and methods. The territorial register of adult patients with severe bronchial asthma (n = 85) who received immunobiological therapy in the Sverdlovsk region in October 2021 was analyzed. When diagnosing chronic inflammatory diseases of the nose, an examination by an otorhinolaryngologist and computed tomography of the paranasal sinuses were performed; were determined: the  absolute number of  blood eosinophils, specific IgE to inhaled allergens, including the Fadiatop^TM method; skin tests were performed; assessment of the severity of nasal symptoms was determined using the SNOT-22, VAS.

Results. Chronic inflammatory diseases of the nose were reported in 89.4% of patients. Allergic rhinitis occurred in 54.1% of cases (n = 46). 54.3% (n = 25) were dominated by patients with a moderate course; severe course was observed in 28.3% of cases (n = 13). Allergic rhinitis in 92.3% of cases (n = 36) was accompanied by allergic asthma and in 71.4% (n = 10) – mixed. Sensitization to household allergens was more common, from seasonal allergens to tree pollen. Phadiatop was positive in all patients with allergic rhinitis and negative in patients with chronic rhinosinusitis with/without nasal polyps. Patients with chronic rhinosinusitis occurred in 35.3% of cases (n=30); nasal polyps were in 23.5% (n = 20). The highest rates of blood eosinophilia were in patients with concomitant chronic rhinosinusitis with nasal polyps – 920 cells/µl. This phenotype in 95% of cases was accompanied by non-allergic (eosinophilic) asthma.

Conclusion. Severe bronchial asthma is almost always accompanied by chronic inflammatory diseases of the nose. Phadiatop shows its high informativeness in determining the phenotype of allergic rhinitis.

1. Licari A., Castagnoli R., Denicolò C.F., Rossini L., Marseglia A., Marseglia G.L. The Nose and the Lung: United Airway Disease? Front Pediatr. 2017;5:44. https://doi.org/10.3389/fped.2017.00044.

2. Katelaris C.H., Lee B.W., Potter P.C., Maspero J.F., Cingi C., Lopatin A. et al. Prevalence and diversity of allergic rhinitis in regions of the world beyond Europe and North America. Clin Exp Allergy. 2012;42(2):186–207. https://doi.org/10.1111/j.1365-2222.2011.03891.x.

3. DeConde A.S., Soler Z.M.. Chronic rhinosinusitis: Epidemiology and burden of disease. Am J Rhinol Allergy. 2016;30(2):134–139. https://doi.org/10.2500/ajra.2016.30.4297.

4. Chuchalin A., Khaltaev N., Antonov N., Galkin D., Manakov L., Antonini P. et al. Chronic respiratory diseases and risk factors in 12 regions of the Russian Federation. Int J Chron Obstruct Pulmon Dis. 2014;9:963–974. https://doi.org/10.2147/COPD.S67283.

5. Emel’yanov A.V., Il’ina N.I., Karneeva O.V., Karpishchenko S.A., Kim I.A., Kurbacheva O.M., et al. Unresolved issues of management of patients with severe allergic rhinitis and nasal polyposis. The possibilities of anti-IgE therapy. Rossiiskaya Otorinolaringologiya. 2020;(3):88–99. (In Russ.) https://doi.org/10.18692/1810-4800-2020-3-88-99.

6. Zacharasiewicz A., Douwes J., Pearce N. What proportion of rhinitis symptoms is attributable to atopy? J Clin Epidemiol. 2003;56(4):385–390. https://doi.org/10.1016/s0895-4356(03)00043-x.

7. Rugina M., Pribil C., Hasnaoui A.El., Chanal I., Rugina M., Pribil C. et al. Characteristics of intermittent and persistent allergic rhinitis : DREAMS study group. Clin Exp Allergy. 2005;(1):728–732. https://doi.org/10.1111/j.1365-2222.2005.02274.x.

8. Licari A., Castagnoli R., Tosca M.A., Marseglia G., Licari A., Castagnoli R. et al. Personalized therapies for the treatment of allergic rhinitis. Expert Rev Precis Med Drug Dev. 2019;4(5):275–281. https://doi.org/10.1080/23808993.2019.1681896.

9. Chichikova N.V. Bronchial asthma and diseases of the nose and paranasal sinuses: the unity of pathological processes in the respiratory system. RMJ. 2015;(18):1132–1136. (In Russ.) Available at: https://www.rmj.ru/articles/bolezni_dykhatelnykh_putey/Bronhialynaya_astma_i_zabolevaniya_polosti_nosa_i_okolonosovyh_pazuh_edinstvo_patologicheskih_processov_v_dyhatelynoy_sisteme/.

10. Astafyeva N.G., Baranov A.A., Vishneva E.A., Daikhes N.A., Zhestkov A.V., Ilyina N.I. et al. Allergic rhinitis: clinical recommendations. Moscow; 2020. 87 р. (In Russ.) Available at: https://cr.minzdrav.gov.ru/schema/261_1.

11. The ENFUMOSA cross-sectional European multicentre study of the clinical phenotype of chronic severe asthma. Eur Respir J. 2003;22(3):470–477. https://doi.org/10.1183/09031936.03.00261903.

12. Dolan C.M., Fraher K.E., Bleecker E.R., Borish L., Chipps B., Hayden M.L. et al. Design and baseline characteristics of The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study: A large cohort of patients with severe or difficult-to-treat asthma. Ann Allergy Asthma Immunol. 2004;92(1):32–39. https://doi.org/10.1016/S1081-1206(10)61707-3.

13. Moore W.C., Bleecker E.R., Curran-Everett D., Erzurum S.C., Ameredes B.T., Bacharier L. et al. Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute’s Severe Asthma Research Program. J Allergy Clin Immunol. 2007;119(2):405–413. https://doi.org/10.1016/j.jaci.2006.11.639.

14. Jarjour N.N., Erzurum S.C., Bleecker E.R., Calhoun W.J., Castro M., Comhair S.A.A. et al. Severe asthma: lessons learned from the National Heart, Lung, and Blood Institute Severe Asthma Research Program. Am J Respir Crit Care Med. 2012;185(4):356–362. https://doi.org/10.1164/rccm.201107-1317PP.

15. Bousquet J., Anto J.M., Wickman M., Keil T., Valenta R., Haahtela T. et al. Are allergic multimorbidities and IgE polysensitization associated with the persistence or re-occurrence of foetal type 2 signalling? The MeDALL hypothesis. Allergy. 2015;70(9):1062–1078. https://doi.org/10.1111/all.12637.

16. Siroux V., Ballardini N., Soler M., Lupinek C., Boudier A., Pin I. et al. The asthma-rhinitis multimorbidity is associated with IgE polysensitization in adolescents and adults. Allergy. 2018;73(7):1447–1458. https://doi.org/10.1111/all.13410.

17. Blaiss M.S., Hammerby E., Robinson S., Kennedy-Martin T., Buchs S. The burden of allergic rhinitis and allergic rhinoconjunctivitis on adolescents. Ann Allergy Asthma Immunol. 2018;121(1):43–52.e3. https://doi.org/10.1016/j.anai.2018.03.028.

18. Bhattacharyya N., Villeneuve S., Joish V.N., Amand C., Mannent L., Amin N. et al. Cost burden and resource utilization in patients with chronic rhinosinusitis and nasal polyps. Laryngoscope. 2019;129(9):1969–1975. https://doi.org/10.1002/lary.27852.

19. Chung K.F., Wenzel S.E., Brozek J.L., Bush A., Castro M., Sterk P.J. et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014;43(2):343–373. https://doi.org/10.1183/09031936.00202013.

20. Heffler E., Blasi F., Latorre M., Menzella F., Paggiaro P., Pelaia G. et al. The Severe Asthma Network in Italy: Findings and Perspectives. J Allergy Clin Immunol Pract. 2019;7(5):1462–1468. https://doi.org/10.1016/j.jaip.2018.10.016.

21. Bresciani M., Paradis L., Roches D., Vachier I., Godard P., Bousquet J. et al. Rhinosinusitis in severe asthma. J Allergy Clin Immunol. 2001;107(1):73–80. https://doi.org/10.1067/mai.2001.111593.

22. Boulet L., Boulay MÈ. Asthma-related comorbidities. Expert Rev Respir Med. 2011;5(3):377–393. https://doi.org/10.1586/ers.11.34.

23. Leynaert B., Neukirch C., Kony S., Guénégou A., Bousquet J., Aubier M. Association between asthma and rhinitis according to atopic sensitization in a population-based study. J Allergy Clin Immunol. 2004;113(1):86–93. https://doi.org/10.1016/j.jaci.2003.10.010.