Contemporary Pharmacotherapy for Allergic Rhinitis and Chronic Rhinosinusitis

Abstract

Chronic rhinosinusitis (CRS) and allergic rhinitis (AR) are chronic conditions causing nasal inflammation. CRS is increasingly recognized as a chronic inflammatory process rather than a chronic infection. Although the primary initiating factors in CRS remain unclear, AR is driven by IgE-mediated hypersensitivity to environmental allergens. Understanding the underlying inflammatory pathways and disease endotypes are driving innovation toward novel pharmacotherapies targeting critical mediators implicated in CRS and AR, including IL-4, IL-13, IL-5, IgE, and epithelial initiators IL-33 and TSLP. Extensive investigations are needed to determine the role, timing, predictive prognostic factors and long-term safety and efficacy of these agents.

Keywords: Biologics; Chronic rhinosinusitis (CRS); Immune specific targeting; Novel pharmacotherapy; Type 2 inflammation.

Figure 1

Roles for biologic therapy in the treatment of CRS. “Induction” medical therapy – could be combined with appropriate medical therapy, less complications than surgery, and at least as efficacious. “Adjuvant” medical therapy enhances effects and durability of surgery. “Salvage” medical therapy – reduces the need for revision surgery, reserved for patients with recalcitrant disease.