Can you imagine how you can live with your nose always closed and practically without sense of smell and taste and undergo surgery even every six months? This is the condition that clearly characterizes people suffering from nasal polyposis, a disease that arises as a result of a specific chronic inflammatory state of the immune system, and which can become a constant throughout life. In fact, in the most severe and chronic forms, not even cortisone-based therapies and surgical removal interventions can solve it. The goal, in these cases, is to alleviate the problem.
What is nasal polyposis?
Nasal polyposis is a chronic inflammatory disease of the nasal cavities. Polyps are benign non-cancerous growths, the origin of which is not yet fully known. Any condition that triggers a chronic inflammatory mechanism in the nasal and paranasal cavities, such as allergies or infections, can considerably increase the risk of its formation. It is therefore no coincidence that nasal polyposis is associated in most cases with chronic rhinosinusitis. Epidemiological studies provide, for chronic rhinosinusitis in general, variable prevalence data depending on the geographic area between 2 and 14 percent. As regards nasal polyposis specifically, the data are estimated to be around 1 to 5 percent, although there is a lack of precise epidemiological studies to estimate it accurately. Asthma is present in percentages ranging from 30 to 60 percent of subjects with nasal polyposis, which can also be associated with atopic dermatitis, allergic rhinitis, eosinophilic esophagitis and, more generally, allergies. This is why the disease may require several consultations before being framed correctly, with the involvement of various specialists: from the otorine to the allergist, from the pulmonologist to the immunologist, from the pediatrician to the rheumatologist.
How is it treated?
Often the symptoms of nasal polyposis, especially in the initial phase, are underestimated. Among them are airway obstruction, facial pain and headache. Up to, in the most advanced forms, the loss of smell and taste. Until now, the only two treatment options were surgery on the one hand and the use of systemic or topical endonasal corticosteroids on the other. However, both options are not decisive, given the high risk of relapses and (as regards cortisone drugs), not without important side effects related to prolonged use. For some months the European Medicines Agency (EMA) has approved the use of a new monoclonal antibody (dupilumab) as an add-on therapy to intranasal corticosteroids for the treatment (in adults) of chronic rhinosinusitis associated with severe nasal polyposis that cannot be treated with cortisone or surgically.
Dupilumab, which in Italy is already used for moderate or severe atopic dermatitis, is a monoclonal antibody that targets the interleukin 4 receptor. Blocking the effects of the molecules involved in type 2 inflammation at the base of nasal polyposis and other associated diseases, Dupilumab has been shown to be effective in reducing exacerbations, improving respiratory function and quality of life.