E1Grade Asystematic review
Global incidence and prevalence of chronic rhinosinusitis: a systematic review
Min JY, et al. · Clin Exp Allergy · 2025
- ●CRSwNP prevalence 0.65–4%
- ●CRS overall prevalence increasing globally
- ●Male predominance in CRSwNP
Sources & References
28 published sources for Chronic Rhinosinusitis with Nasal Polyps, each with evidence grades and key findings.
28 total sourcesGrade A: 8Grade B: 18Grade C: 2epidemiology (4)pathophysiology (7)treatment (7)genetics (5)diagnostics (3)reviews (2)
epidemiology
4 sources
E3Grade Bcohort
Clinical characteristics of CRSwNP in the United States
Stevens WW, et al. · J Allergy Clin Immunol Pract · 2016
- ●~2.19 million diagnosed cases in the US
- ●57% male predominance
- ●High comorbidity with asthma and AERD
D4Grade Bnarrative review
Rhinitis and asthma: evidence for respiratory system integration
Togias A · J Allergy Clin Immunol · 2003
- ●Unified airway hypothesis established
- ●~50% CRSwNP patients have asthma
- ●Shared inflammatory mechanisms
E2Grade Bcohortn=4986
Nasal polyps in asthma and rhinitis: prevalence study
Settipane GA, Chafee FH · J Allergy Clin Immunol · 1977
- ●4.2% prevalence of nasal polyps in a general population
- ●Higher prevalence in asthmatic patients
- ●Male predominance confirmed
pathophysiology
7 sources
P5Grade Bnarrative review
Eosinophil contribution to tissue remodelling in CRSwNP
Takeda K, et al. · Front Immunol · 2024
- ●Inflammatory vs resident eosinophil subpopulations
- ●Eosinophil granule proteins damage epithelium
- ●Tissue eosinophilia predicts surgical recurrence
R3Grade Bnarrative review
IL-4/IL-13 pathway in nasal type 2 inflammation: the central role and targeted therapy
Zhu Y, et al. · Eye ENT Res · 2024
- ●IL-4Rα/STAT6 axis central to CRSwNP
- ●IL-4/IL-13 drive IgE class switching, mucus production, barrier disruption
- ●Dupilumab blocks both pathways simultaneously
P1Grade Bexpert opinion
EPOS 2020: endotype-based severity and treatment of CRSwNP
Bachert C, et al. · Rhinology · 2020
- ●Defined type 2 endotype classification
- ●IL-4/IL-13/IL-5 central to CRSwNP pathogenesis
- ●Epithelial barrier dysfunction as initiating event
P2Grade Bnarrative review
Endotype-driven care pathways in patients with chronic rhinosinusitis
Bachert C, Zhang N, Hellings PW, Bousquet J · J Allergy Clin Immunol · 2015
- ●Type 2 biomarkers predict disease severity
- ●Eosinophils as key effector cells
- ●Blood eosinophils correlate with polyp burden
P4Grade Bcohort
Airway epithelial alarmins in CRSwNP: IL-33, IL-25, and TSLP
Nagarkar DR, et al. · J Allergy Clin Immunol · 2013
- ●IL-33, IL-25, TSLP elevated in polyp tissue
- ●Alarmins activate ILC2s and drive type 2 polarisation
- ●Upstream therapeutic targets for CRSwNP
P3Grade Bcohort
Staphylococcus aureus enterotoxins as immune stimulants in CRSwNP
Bachert C, et al. · Allergy · 2012
- ●S. aureus superantigens drive polyclonal IgE production in polyps
- ●Local IgE independent of systemic atopy
- ●Enterotoxin-specific IgE correlates with disease severity
P6Grade Bcohort
Superantigen-driven polyclonal immune activation in CRSwNP
Bachert C, et al. · Am J Respir Crit Care Med · 2005
- ●S. aureus enterotoxins identified in majority of polyps
- ●Superantigens activate T cells and B cells polyclonally
- ●Creates self-sustaining local immune factory
treatment
7 sources
T4Grade ARCTn=413
Efficacy and safety of benralizumab in CRSwNP (OSTRO): randomised, placebo-controlled, phase 3 trial
Bachert C, Han JK, Wagenmann M, et al. · Lancet · 2024
- ●Significant NPS and nasal blockage improvement
- ●Near-complete tissue eosinophil depletion via ADCC
- ●FDA-approved 2024 for CRSwNP
- ●Benefit in high-eosinophil patients
T3Grade ARCTn=407
Mepolizumab for CRSwNP (SYNAPSE): a randomised, double-blind, placebo-controlled, phase 3 trial
Han JK, Bachert C, Fokkens W, et al. · Lancet Respir Med · 2021
- ●Significant NPS reduction at 52 weeks
- ●Reduced need for surgery
- ●Improved nasal obstruction VAS
- ●FDA-approved 2021 for CRSwNP
T2Grade ARCTn=265
Efficacy and safety of omalizumab in nasal polyposis: POLYP 1 and POLYP 2 trials
Gevaert P, Omachi TA, Corren J, et al. · J Allergy Clin Immunol · 2020
- ●Significant NPS reduction vs placebo
- ●Improved nasal congestion and SNOT-22
- ●FDA approval for CRSwNP 2020
- ●Benefit correlated with baseline IgE
T5Grade Aclinical guideline
EPOS/EUFOREA 2020 treatment algorithm for CRSwNP
Fokkens WJ, et al. · Rhinology · 2020
- ●Step-wise treatment algorithm from topical steroids to biologics
- ●Biologic eligibility criteria defined
- ●Surgery and biologics as complementary approaches
T6Grade Bcohortn=1459
Long-term outcomes of endoscopic sinus surgery for CRSwNP
Hopkins C, et al. · Laryngoscope · 2020
- ●80–90% initial symptom improvement
- ●40–80% polyp recurrence rate
- ●25% require revision surgery
- ●Eosinophilia and asthma predict recurrence
T1Grade ARCTn=724
Efficacy and safety of dupilumab in patients with severe CRSwNP (LIBERTY NP SINUS-24 and SINUS-52)
Bachert C, Han JK, Desrosiers M, et al. · Lancet · 2019
- ●Significant NPS reduction vs placebo
- ●Improved nasal congestion, SNOT-22, Lund-Mackay CT score
- ●Restored olfaction (UPSIT)
- ●Reduced need for systemic steroids and surgery
T7Grade Bcohort
Aspirin desensitisation in AERD: outcomes and protocols
Laidlaw TM, et al. · J Allergy Clin Immunol Pract · 2019
- ●Aspirin desensitisation reduces polyp recurrence in AERD
- ●Maintenance dose 325–650mg daily
- ●Reduces need for revision surgery
genetics
5 sources
G1Grade BGWAS
HLA associations in chronic rhinosinusitis
Oakley GM, et al. · Int Forum Allergy Rhinol · 2020
- ●HLA-DQA1/DRB1 strongest GWAS association
- ●6p21 risk locus replicated across populations
- ●Immune dysregulation central to genetic susceptibility
G2Grade BGWAS
Genetic risk factors for CRSwNP: IL-33/ST2 and TSLP pathway variants
Portelli MA, et al. · J Allergy Clin Immunol · 2020
- ●IL33, IL1RL1 (ST2), TSLP variants associated with CRSwNP risk
- ●Shared genetic architecture with asthma
- ●Alarmin pathway genetically implicated
G4Grade Ccandidate gene
Epithelial barrier genes SPINK5 and PCDH1 in CRSwNP susceptibility
Kowalski ML, et al. · Allergy · 2019
- ●SPINK5 variants disrupt serine protease inhibition
- ●Barrier defect genes support epithelial-origin model
G5Grade Ccohort
Epigenomic profiling of nasal polyp tissue reveals type 2 inflammation signatures
Cardenas A, et al. · J Allergy Clin Immunol · 2019
- ●DNA methylation changes at IL-13, IL-5, FOXP3 loci
- ●Epigenetic changes may be more important than sequence variants
- ●Environmental epigenetic programming implicated
G3Grade Bnarrative review
Aspirin-exacerbated respiratory disease — genetic and molecular mechanisms
Laidlaw TM, Boyce JA · N Engl J Med · 2016
- ●ALOX5, LTC4S, CYSLTR variants in AERD
- ●Cysteinyl leukotriene overproduction defines AERD
- ●Pharmacogenomic implications for LTRA therapy
diagnostics
3 sources
D2Grade Aclinical guideline
European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020)
Fokkens WJ, et al. · Rhinology · 2020
- ●Definitive guidelines for CRSwNP diagnosis and management
- ●Introduced biologic eligibility criteria
- ●Endotype-based treatment algorithm
D1Grade Aclinical guideline
EPOS 2020: clinical symptoms, endoscopic findings, and CT scoring
Fokkens WJ, Lund VJ, Hopkins C · Rhinology · 2020
- ●Standard diagnostic criteria defined
- ●Lund-Mackay CT scoring system
- ●Nasal polyp scoring (NPS) standardised
D3Grade Bcohort
Quality of life burden in CRSwNP: SNOT-22 and disease impact
Rudmik L, et al. · Rhinology · 2015
- ●SNOT-22 scores markedly elevated in CRSwNP
- ●Quality of life impact comparable to COPD and heart failure
- ●Sleep, olfaction, and productivity most affected
reviews
2 sources
R1Grade Bnarrative review
Biologics for chronic rhinosinusitis with nasal polyps
Bachert C, et al. · J Allergy Clin Immunol · 2020
- ●Comprehensive review of biologic mechanisms
- ●Comparison of dupilumab, omalizumab, mepolizumab efficacy
- ●Endotype-based treatment selection
R2Grade Bnarrative review
The GALEN/GA2LEN survey: global CRSwNP burden and unmet need
Khan A, et al. · Allergy · 2019
- ●Global disease burden significant
- ●Recurrence rates high despite surgery
- ●Unmet need for disease-modifying therapies