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Correction to: Clinically relevant phenotypes in chronic rhinosinusitis

  • Jessica W. GraysonEmail author
  • Marina Cavada
  • Richard J. Harvey
Open Access
Correction
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Correction to: J Otolaryngol Head Neck Surg

https://doi.org/10.1186/s40463-019-0350-y

Following publication of the original article [1], the authors reported an error in Table 1. In the second columns of the ‘Radiology’ row, ‘Normal anterolateral sinus mucosa’ should read ‘Normal superolateral sinus mucosa’. A corrected version of Table 1 is included in this Correction.
Table 1

Summary of Key Findings of CRS Phenotypes

 

Phenotype

Characteristics

CCAD (IgE mediated)

eCRS (AERD)

Non-eCRS

Clinical Presentation

- Young onset (teens to 20s)

- Rhinitis symptoms

- Smell preserved

- Other atopic disease:

° Childhood asthma

° conjunctival symptoms, dermatitis

- Mid-Life “adult” onset (30–50 yo)

- Occasionally post respiratory virus

- “Completely well” prior to onset or if allergic, then symptoms limited to childhood

- Smell loss (corticosteroid responsive)

- Antibiotic seeking

- Food and alcohol induced flares

- Adult onset asthma linked temporally to CRS onset.

- Older onset 50 yrs.+

- Female, obese

- Cough

- Poor corticosteroid response

- “Asthma” present but often poor response to inhaled preventive therapy (corticosteroid based)

Endoscopy

- Middle turbinate edema

- Polypoid changes from turbinates and septum

- No thick mucin

- Normal sinus mucosa on surgery

- Polyps (small, multiple, large) from the middle meatus

- Thick eosinophilic mucin

- Secondary purulence

- Polyps or polypoid edema

- Purulent secretions

- Lack of eosinophilic mucin

Radiology

- Central thickening of septum and turbinates, peripheral clearing (CCAD)

- Mucus trapping only in sinsues

- Normal superolateral sinus mucosa (“black halo”)

- Pan-sinusitis (Lund-Mackay 24)

- Neo-osteogenesis

- Pan-sinusitis (undistinguishable from eCRS)

Histopathology

- Elevated tissue eosinophilia

- Often without activation (no eosinophil aggregates and charcot-leyden crystals)

- No serum eosinophils

- Elevated total and specific IgE

- Elevated tissue eosinophilia (>10eos/hpf, but often >100eos/hpf)

- Evidence of eosinophil activation (eosinophil aggregates and charcot-leyden crystals)

- Serum eosinophilia

- Lack of tissue eosinophilia (< 10/HPF)

Allergy

- + allergy testing (dustmite/perennial allergens)

- Often monoallergen-sensitized

- Either negative IgE sensitization or multi-allergen sensitized

- Negative skin prick, immunocap/RAST

Treatment

- Allergen directed immunotherapy

- Endoscopic sinus surgery

- Topical corticosteroid (spray or irrigation)

- Systemic corticosteroid treatment (up to 2–3 times per year) if limited burden of disease

- Endoscopic sinus surgery (Draf 3)

- Topical corticosteroid irrigations (not sprays)

For AERD:

- Zileuton, Montelukast, Zafirlukast

- Can take selective COX-2 inhibitors (Meloxicam)

- Saline or corticosteroid irrigations

- Endoscopic sinus surgery

- Macrolide therapy (Clarithromycin 250 mg daily for 3 months)

- Continue 3/week until 12 months if responder

Difficult to control disease

- Omaluzimab (anti-IgE)

- Mepoluzimab (anti-IL5)

- Other immune-modulating therapy (Benraluzimab, Dupiliumab, Reslizumab, etc)

For AERD:

- ASA desensitization (1300 mg commencement and 350–700 mg daily maintenance)

- Consider re-biopsy of a patient post-surgery and post-corticosteroid based treatment if not responding and may be re-classified under this phenotype

Reference

  1. 1.
    Grayson, et al. Clinically relevant phenotypes in chronic rhinosinusitis. J. Otolaryngol. Head Neck Surg. 2019;48:23  https://doi.org/10.1186/s40463-019-0350-y.CrossRefGoogle Scholar

Copyright information

© The Author(s). 2019

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Jessica W. Grayson
    • 1
    Email author
  • Marina Cavada
    • 1
    • 2
  • Richard J. Harvey
    • 1
    • 2
  1. 1.Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical ResearchUniversity of New South WalesSydneyAustralia
  2. 2.Department of Otolaryngology, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyAustralia

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