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Review
. 2025 May 9;18(5):101058.
doi: 10.1016/j.waojou.2025.101058. eCollection 2025 May.

ARIA-Italy multidisciplinary consensus on nasal polyposis and biological treatments: Update 2025

Carlo Lombardi  1 , Rikki F Canevari  2 , Diego Bagnasco  3 , Maria Beatrice Bilò  4 , Giorgio Walter Canonica  5 , Cristiano Caruso  6 , Paolo Castelnuovo  7 , Lorenzo Cecchi  8 , Orietta Calcinoni  9 , Mauro Carone  10 , Marco Cassatella  11 , Renato Cutrera  12 , Gianni Danesi  13 , Eugenio De Corso  14 , Mario Di Gioacchino  15 , Fabiano Di Marco  16 , Stefania Gallo  17 , Matteo Gelardi  18 , Enrico Heffler  5 , Clara Imperatore  19 , Cristiana Indolfi  20 , Massimo Landi  21 , Amelia Licari  22 , Francesco Liotta  23 , Alberto Macchi  7 , Luca Malvezzi  24 , Sara Manti  25 , Francesco Menzella  26 , Claudio Micheletto  27 , Fabio Midulla  28 , Michele Miraglia Del Giudice  21 , Antonino Musarra  29 , Vincenzo Patella  30 , Diego Peroni  31 , Laura Petrarca  32 , Giorgio Piacentini  33 , Alessandro Pusateri  34 , Veronica Seccia  35 , Gianenrico Senna  36 , Adriano Vaghi  37 , Carlo Vancheri  38 , Giovanni Passalacqua  3 ; ARIA Italy; ARIA-ITALY PANEL
Collaborators, Affiliations
Review

ARIA-Italy multidisciplinary consensus on nasal polyposis and biological treatments: Update 2025

Carlo Lombardi et al. World Allergy Organ J. .

Abstract

In recent years, it was recognized that type-2 inflammation connects nasal polyposis and severe asthma (SA) in addition to other type-2 diseases. Thus, some biological drugs developed for SA appeared to exert a favourable effect also in nasal polyposis. So far, there are several trials supporting this concept; therefore, some monoclonal antibodies already used for SA were assessed also in chronic rhinosinusistis with nasal polyposis (CRSwNP), with promising results. Since different specialists are involved in the management of nasal polyposis (eg, pulmonologists, ENT specialists, allergists, immunologists, pediatricians), it was felt that an updated educational and informative document was needed to better identify the indications of biological therapies in nasal polyposis. We collected the main Italian scientific societies, and prepared (under the umbrella of Allergic Rhinitis and its Impact on Asthma, ARIA) a document endorsed by all societies, to provide a provisional statement for the future use of monoclonal antibodies (MAbs) as a medical treatment for polyposis, possibly associated with SA. The above mentioned document was the first endorsed document on this aspect, and the additional evidence required an update. The current pathogenic knowledge and the experimental evidence are herein reviewed, and some suggestions for a correct prescription and follow-up are provided.

Keywords: ARIA (allergic rhinitis and its impact on asthma); Biological agents; Chronic rhinosinusitis with nasal polyposis; Monoclonal antibodies; Personalized medicine; Severe asthma.

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Conflict of interest statement

The authors report no competing interests.

Figures

Fig. 1
Fig. 1
“CRSwNP pathogenetic mechanisms” from Shah SA et al.
Fig. 2
Fig. 2
“Actual proposals for prescription (A) and discontinuation (B) of biologicals in CRSwNP” from Fokkens WJ et al.
Fig. 2
Fig. 2
“Actual proposals for prescription (A) and discontinuation (B) of biologicals in CRSwNP” from Fokkens WJ et al.
Fig. 3
Fig. 3
“POLINA Consensus criteria for the use of biologics (A) (Legenda: VAS: visual analog scale; SNOT-22: Sino-Nasal Outcome Test-22; HPF: high-power field; N-ERD: NSAID-exacerbated anti-inflammatory drugs. (a) VAS >7 cm and/or SNOT-22 > 50; (b) Opening of affected paranasal sinuses >6 months; (c) Short courses from 5 days at a dose of 0.5–1 mg/kg/d) and for the evaluation of biological treatment at 6 and 12 months (B) (Legenda: (a) See POLINA control criteria; (b) Endoscopic sinus surgery with opening of affected paranasal sinuses; (c) Oral corticosteroids for 5 days at a dose of 0.5–1 mg/kg/d)”. from Alobid I et al.
See this image and copyright information in PMC

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