A Precision Medicine Approach to Rhinitis Evaluation and Management

Abstract

Purpose of review: Precision medicine (PM) represents a new paradigm in disease diagnosis, prevention, and treatment. The PM approach focuses on the characterization of different phenotypes and pathogenic pathways in order to allow the selection of specific biomarkers that will be useful in disease management. Rhinitis is a highly prevalent and heterogeneous disease, both in terms of underlying endotypes and clinical presentations. Therefore, to apply the PM principles to the various rhinitis subtypes rise as a meaningful strategy to improve evaluation and treatment.

Recent findings: The technology of recombinant allergens has allowed molecular characterization of IgE reactivity of specific individual components of allergenic extracts. Recently published and ongoing clinical trials based on component resolved diagnosis (CRD) bring more precision to allergen immunotherapy for allergic rhinitis. Monoclonal antibodies against various cytokines involved in inflammatory allergic and nonallergic rhinitis endotypes show promissory results.

Summary: Better understanding of pathogenic pathways together with an accurate phenotype classification of patients presented with rhinitis symptoms contributes to point out clinical usefulness of biomarkers and other diagnostic tools, which leads to more accurate environmental control measures, personalized pharmacologic options, and new biological therapy developments.

Keywords: Biomarkers; Endotypes; Management algorithm; Phenotypes; Precision medicine; Rhinitis.

Fig. 1

A precision medicine approach to rhinitis evaluation and management. NHR nasal hyperreactivity, nNO nasal nitric oxide, ACT axial computed tomography, SPT skin prick test, ECP eosinophylic cationic protein, HMW high molecular weight, AR allergic rhinitis, ARIA allergic rhinitis and its impact on asthma guide, NAPT nasal allergen provocation test, AIT allergen immunotherapy, NAR nonallergic rhinitis, NARES nonallergic rhinitis with eosinophilia syndrome, CRSwNP chronic rhinosinusitis with nasal polyps, CRSsNP chronic rhinosinusitis without nasal polyps, sIgE-SE specific IgE against to S. aureus enterotoxin E, MPO myeloperoxidase, SP substance P, TRPV-1 transient receptor potential cation channel subfamily V member 1, LTE4 leukotriene E4, AERD aspirin-exacerbated respiratory disease, Mab monoclonal antibody. Asterisk indicates Mab target cytokines IL-4/IL-13 (dupilumab) via blocking the IL-4 receptor alpha, IL-5 (mepolizumab), and IL-5 receptor alpha (benralizumab) as well as IgE (omalizumab).