Rethinking neutrophils and eosinophils in chronic rhinosinusitis.

Delemarre, Tim; Bochner, Bruce S; Simon, Hans-Uwe; Bachert, Claus (2021). Rethinking neutrophils and eosinophils in chronic rhinosinusitis. Journal of allergy and clinical immunology, 148(2), pp. 327-335. Elsevier 10.1016/j.jaci.2021.03.024

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Chronic rhinosinusitis (CRS) often is characterized by an eosinophilic inflammatory pattern, nowadays referred to as type 2 inflammation, although the mucosal inflammation is dominated by neutrophils in about a third of the patients. Neutrophils are typically predominant in 50% of patients with CRS without nasal polyps, but also are found to play a role in patients with severe type 2 CRS with nasal polyp disease. This review aims at summarizing the current understanding of the eosinophilic and neutrophilic inflammation in CRS pathophysiology, and provides a discussion of their reciprocal interactions and the clinical impact of the mixed presentation in patients with severe type 2 CRS with nasal polyps. A solid understanding of these interactions is of utmost importance when treating uncontrolled severe CRS with nasal polyps with biologicals that are preferentially directed toward type 2 inflammation. We here focus on recent findings on both eosinophilic and neutrophilic granulocytes, their subgroups and the activation status, and their interactions in CRS.

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